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Full text of "First lines of the practice of physic (Volume 3)"

NATIONAL LIBRARY OF MEDICINE 
Washington 




Founded 1836 



U. S. Department of Health, Education, and Welfare 
Public Health Service 



FIRST LINES 

PRACTICE of PHYSIC. 



B Y 

WILLIAM CULLEN, M. D. 

Profeflbr of the Practice of Phyfic in the Univerfity of Edinburgh \ 
Firft Phytician to his Britannic Majefty for Scotland ; 
Fellow of the Royal College of Phyficians of Edinburgh ; 

Of the Royal Societies of London and of Edinburgh, 
Of the Royal Society of Medicine of Paris, Sec. &■:. &c. 

A NEW EDITION. 

From the Laft British Edition, 

Revised, Corrected and Enlarged, by the Author, 



IN THREE. VOLU ME S. 

======= 

Vol. III. 
— imm — ■ r , 

printed at WO RCE S TER, Massachusetts, ^ 
by ISAIAH THOMAS. 

Sold at his Bookstore in WORCESTER, and by him and 
Company in BOS TON. 

MDCCXU ' 





?^f/AM*Q 




/X -<&**& 



JU 






CONTENTS 
of VOL. III. 

PART II. 

BOOK III. ^ 

Page 

Of spasmodic af- 
fections, without FEVER 9 

SECT. I. 

Of the Spasmodic Affections of the 
Animal Functions - 11 

I 

Chap. I. Of Tetanus - - 13 

Chap. II. Of Epilepfy - 33 

Chap. III. Of the Chorea, or Dance 
of St. Vitus 66 

SEC T. II. 

0/ the Spasmodic Affections of the 
Vital Functions - 70 

Chap, 



iv CONTENTS. 

4 

Page 
Chap. IV.* "Of the Palpitation of the 
Heart JO 

Chap. V. Of Dyfpncea, or Difficult 

Breathing - - j§ 

Chap. VI. Of Aflhma - 79 

Chap. VII. Of the Chincough t or 
Hoopingcough - - 94 

SECT. III. 

Of the Spasmodic Affections in the 
Natural Functions - 109 

Chap. VIII. Of the Pyrofis, or what 
is named in Scotland the Water Brafh 109 

Chap. IX. Of the Colic - 114 

Chap. X. Of the Cholera - 126 

Chap. XI. Of Diarrhoea, or Loofe- 
™J> - 132 

Chap. 

* Though I have thought it proper to divide this book 
into teaions, I think it neceflary, for the convenience of 
reference?, to number the chapters from the beginning. 



t» 



C O N T Ji in i 3. v 

Page 

Chap. XII. Of the Diabetes - 153 

Chap. XIII. Of the Hyjleria, or the 
Hyjleric Difeafe - - 160 

Chap. XIV. Of Canine Madnefs and 

Hydrophobia - - 168 

BOOK IV. 

or VESANIjE, or of the DISOR- 
DERS of the INTELLECTUAL 
FUNCTIONS - - 171 

C H A P. I. 

Of Vesanive in general - * 171 

C II A P. II. 

fl/MANiAjOr Mabness - 192 

C H A If. III. 

Of Melancholy, and other forms of 
Jnfanity - - - 208 

A 2 PART 



Page 



vi CONTENTS. 

PART III. 
of CACHEXIES - - 22i 

BOOK I. 
of EMACIATIONS 

BOOK II. 



223 



of INTUMESCENTI^,, or GEN- 
ERAL SWELLINGS 

*^ 

C HT A^ P. I. 



239 



0/Adipose Swellings - 241 

CHAP. II. 

0/Flatulent Swellings - 246 

CHAP. III. 

0/ Watery Swellings, or Drop- 
SIES - 260 

Seft. I. Of Anafarca m 2 ~ 7 

Sea. 



CONTENTS. vii 

Page 
Seel:. II. Of theHydrothorax.or Drop- 
fy of the Bteafl - - 296 

Sett. III. Of Af cites, or Dropfy of the 
Lower Belly - - 304 

CHAP. IV. 

O/General SwELLiNGs^rifngfrom 
an increafed Bulk of the whole Sub- 
stance oy^flr^cw/ar - Parts - 311 

Of Rachitis, or Rickets - 312 

BOOK III. 

OF THE IMPETIGINIS, OR DEPRAV- 
ED HABIT with AFFECTIONS 

OF THE SKIN ! - 028 

CHAP. I. 

0/Scrophula, or the King's Evil 329 

C H A iP. II. 

O/Siphylis, or the Venereal Dis- 
ease - 344 

CHAP. 



viii CONTENTS. 



CHAP. 


III. 




0/ScURVY 


- 


3^3 


CHAP. 


IV. 




Of Jaundice 


- 


378 



*> 



I 



FIRST 




FIRST LINES 

OF THE 

PRACTICE of PHYSIC. 

PART II. 
BOOK III. 



of SPASMODIC AFFECTIONS, 
without FEVER. 

m 
f 

MCCLI. 

NDER this title I am to 
comprehend all the difeafes 
which cbnfifl in motu ab- 
normi ; that is, in. a preter- 
natural ftate of the contrac- 
tion and motion of the muf- 
cular or moving fibres in 
any part of the body. 

MCCLII. 




I 

jo PRACTICE 

m 

MCCLII. 

It will hence appear, why, under this title, 
I have comprehended many more difeafes 
than Sauvages and Sagar have comprehended 
under the title of Spafmi, or than Linnaeus has 
done under the title of Motorii. But I ex . 
pe£r. it will be obvious, that, upon this occa- 
fion, it would not be proper to confine our view 
•lo the affeftions of voluntary motion only; and 
if thofe Nofologifts have introduced into the 
clafs of Spafmi, Palpitatio and Hyfteria, it 
will be with equal propriety that Afthma, Col- 
ica, and many other difeafes, are admitted. 

MCCLIII. 

It has been hitherto the method of our No- 
fologifts to . divide the Spafmi into the two 
orders of Tonici and Clonici, Spaftici and 
Agitatorii ; or, as many at prefent ufe the 
terms, into Spafrns ftridly fo called, and 
Conyulfions. I find, however, that many, 
and indeed moil of t£e difeafes to be confid- 
ered under our title bf Spafmodic Affeaions, 
in refpeft of Tonic or Clonic contraaions, 
are of a mixed kind : And, therefore, I can- 
not follow the ufual general divifion ; but 
have attempted another, by arranging the 
feveral Spafmodic Difeafes according as they 
affea the feveral funaions, Animal' Vital or 
Natural. 



SECT. 






ftp 



OF PHYSIC. it 



SECT. I. 



op the SPASMODIC AFFECTIONS of 
the ANIMAL FUNCTIONS. 

MCCLIV. 

Agreeable to the lan- 
guage of the ancients, the whole of the dif- 
eafes to be treated of in this fettion might be 
termed Spa/mi ; and many of the moderns 
continue to apply the term in the fame man- 
ner : But I think it convenient to diftinguifh 
the terms of Spafm and Convulfion, by apply- 
ing the former, ftri&ly to what has been call- 
ed the Tonic ; and the latter, to what has 
been called the Clonic Spafm. There is cer- 
tainly a foundation for the ufe of thofe dif- 
ferent terms, as there is a remarkable differ- 
ence in the ftate of the contraction of moving 
fibres upon different occafions. This I have 
indeed pointed out before in my treatife of 
Phyfiology, but rauft alfo repeat it here. 

MCCLV. 

In the exercife of the feveral functions of 
the animal economy, the contractions of the 
moving fibres are excited by the will, or by 
certain other caufes fpecially appointed by 
nature for exciting thofe contractions ; and 

thefe 



32 PRACTICE 

ihefe other caufes I name the natural caufes. 
In a ftate of health, the moving fibres are 
contracted by the power of the will, and by 
the natural caufes only. At the lame time 
the contradions produced are in force and 
velocity regulated by the will, or by the cir- 
cumftances of the natural caufes ; and the 
contractions, whether produced by the one 
or the other, are always foon fucceeded by a 
Rate of relaxation, and are not repeated but 
when the power of the will or of the natural 
caufes is again applied. 

MCCLVI. 

^- • 

Such are the conditions of the action of 
the moving fibres in a ftate of health ; but in 
a morbid date, the contractions of the mufcles 
and moving fibres ordinarily depending upon 
the will are excited without the concurrence 
of the will, or contrary to what the will in- 
tends ; and in the other functions they are 
excited by the action of unufiial and unnat- 
ural caufes. In both cafes, the contractions 
produced may be in two 'different flates. 

The one is, when the contractions are to a 
more violent degree than is ufual in health, 
and are neither fucceeded by a fpontaneous 
relaxation, nor even readily yield to an ex- 
tenfion either from the action of antagon'ift 
mufcles, or from other extending powers ap^ 
plied. This ftate of contractions is what has 
been called a Tonic Spafm, and is what I fhall 
name fimply and ftrictly a Spafm. 

The 



OF PHYSIC. 13 

The other morbid date of contraction is, 
when they are fucceeded by a relaxation, but 
are immediately again repeated without the 
concurrence of the will or of the repetition of 
natural caufes, and are at the fame time com- 
monly, with refpeft to velocity and force, 
more violent than in a healthy Mate. This 
ftate of morbid contraction is what has been 
named a Clonic Spafm, and what I fhall name 
fimply and ftri&ly a Convulfion. 

In this fe&ion I {hall follow nearly the ufual 
divifion of the fpafmodic difeafes jnto thofe 
confining in Spafm, and thofe confining in 
Convulfion j but it may not perhaps be in 
my power to follow fuch divifion exactly. 



C 11 a p. I. 

Of T E T A N U 

MCCLVII. 



BOTH Nofologifts and Practical Writers 
have diftinguifhed Tetanic complaints into 
the feveral fpecies of Tetanus, Opiflho- 
tonos, and Emprofthotonos ; and I have in 
my Nofology put the Trifmus, or Locked 
jaw, as a genus diflinft from the Tetanus* 

Vol. III. B All 



14 PRACTICE 

All this, however, I now judge to be im- 
proper ; and am of opinion, that all the 
fevcral terms mentioned, denote, and are 
applicable only to, different degrees of one and 
the fame difeafe ; the hiftor,y and cure of 
which I (hall endeavour to deliver in this 
chapter. 

MCCLVIIi. 

Tetanic complaints may, from certain cauf- 
occur in every climate that we are ac- 
quainted with ; but they occur moll fre- 
quently in the warmed climates, and moll 
commonly in the warmefl feafons of fuch 
climates. Thefe complaints affect all ages, 
fixes, temperaments, and complexions. The 
caufes from whence they commonly proceed, 
are cold and moiflure applied to the body 
while it is very warm,and efpecially the fudden 
viciffitudes of heat and cold. Or, the difeafe 
is produced by punctures, lacerations, or oth- 
er lefions of nerves in any part of the body. 
There are, probably, fome other caufes of 
this difeafe ; but they are neither diflinctly 
known, nor well afcertained. Though the 
caufes mentioned do, upon occafion, affect all 
forts of perfons, they feem however to attack 
perfons of middle age more frequently than 
the older or younger, the male fex more fre- 
quently than the female, and the robufl and 
vigorous more frequently than the weaker. 

MCCLIX-. 



OF PHYSIC. 15 



MCCLIX. 

If the difeafe proceed from cold, it com- 
monly comes on in a few days after the ap- 
plication of fuch cold ; but, if it arife from a 
punclure or other lefion of a nerve, the difeafe 
does not commonly come on for many days 
after the lefion has happened, very often when 
there is neither pain nor uneafmefs remaining 
in the wounded or hurt part, and very fre- 
quently when the wound has been entirely 
healed up. 

MCCLX. 

The difeafe fometimes comes on fuddenly 
to a violent degree, but more generally it ap- 
proaches by flow degrees to its violent ftate. 
In this cafe it comes on with a fenfe of ftiff- 
n-efs in the back part of the neck, which, grad- 
ually incre.rfmg, renders the motion or' the 
Iread difficult and painful. As the rigidity 
of the neck comes on and increafes, there is 
•commonly at the fame time a [en(e of un- 
eafmefs felt about the root of the tongue; 
which, by degrees, becomes a difficulty of fwal- 
lowing, and at length an entire interruption of 
it. While the rigidity of the neck goes on in- 
creafing, there arifes a pain, often violent at 
the lower end of the fternum, and from thence 
mooting into the back. When this pain 
ariles, all the mufcles of the neck, and partic- 
le 2 ularly 



16 PRACTICE 

-tilarly thofe of the back part of it, are imme* 
diately affeaed with fpaim, pulling the head 
itrongly backwards. At the fame time, the 
mufcles that pull up the lower jaw, which up- 
on the firft approaches of the difeafe were af- 
feaed with lome fpaftic rigidity, are now gen- 
erally affeaed with more violent fpaim, and 
let the teeth fo clofely together that they do 
not admit of the fmallefl opening. 

This is what has been named the Locked 
Jaw, and is often the principal part of the 
difeafe. When the difeafe has advanced thus 
far, the pain at the bottom of the fternum re- 
turns very frequently, and with it the fpafms 
'of the hind neck and lower jaw are renewed 
with violence and much pain. As the difeafe 
thus proceeds, a greater number of mufcles 
•come to be affeaed with fpafms. After thofe 
of the neck, thofe along the whole of the 
fpine become affeaed, tending the trunk of 
the body ftrongly backwards ; and this is 
■what has been named the Opijlhoi nos. 

In the lower extremities, both the flexor 
and extenfor mufcles are commonly at the 
fame time affeaed, and keep the limbs rigidly 
extended. Though the extenfors of the head 
and back are ufually the mod ftrongly affea- 
ed, yet the flexors, or thofe mufcles of the 
neck that pull the head forward, and the 
mufcles that fhould pull down the lower jaw, 
are often at the fame time ftrongly affeaed 
with fpafm. During the whole of the dif- 
eafe, the abdominal mufcles are violently af- 

fe&edt 



OF PHYSIC. 17 

fcfted with fpafm, fo that the belly is ftrong* 
ly retracted, and feels hard as a piece of 
board. 

At length the flexors of the head and trunk 
become fo flrongly affected as to balance the 
extenfors, and to keep the head ; and 'trunk 
flraighr, and rigidly extended, incapable of 
being moved in any way ; and- it is to this 
Hate the term of Ttianus has been uriclly ap- 
plied. At the fame time, the arms, little af- 
fected before, are now- rigidly extended ; the 
whole of the mufcles belonging to them being 
affected with fpafms,- except thofe that move 
the fingers, which often to the laft retain fome 
mobility. The tongue alfo long retains its 
mobility ; but at length it alfo becomes af- 
fe&ed with fpafms, which, attacking certain of 
its mufcles only, often thruft it violently out 
between the teeth. 

At the height of the difeafe, every organ 
of voluntary motion feems to be affected ; 
and amongft the reft, the mufcles of the face. 
The forehead is drawn up into furrows, the 
eyes, fometimes diflorted, are commonly rigid, 
and immoveable in their fockets ; the nofe is 
drawn up, and the cheeks are drawn back- 
wards towards the ears, fo that the whole 
countenance expreffes the moil violent grin- 
ning. Under thefe univerfal fpafms, a vio- 
lent convulfion commonly comes on, and 
puts an end to life. 

B 3 MCCLXI* 



18 PRACTICE 



MCCLXI. 

Thefe fpafriis are every where attended 
with moft violent pains. The utmofl vio- 
lence of fpafm is, however, not conftant ; but, 
after fubfifting for a minute or two, the muf- 
cles admit of fome remiflion of their contrac- 
tion, although of no fuch relaxation as can 
allow the aftion of their antagonifts. This 
remiflion of contraction gives alio fome re- 
miflion of pain ; but neither is of long dura- 
tion. From time to time, the violent con- 
tractions and pains are renewed fometimes 
every ten or fifteen minutes, and that often 
without any evident exciting caufe. But 
fuch exciting caufes frequently occur ; for 
almoft every attempt to motion, as attempt- 
ing a change of poflurc, endeavouring to 
fwallow, and even to (peak, fometimes gives 
occafion to a renewal of the fpafms over the 
whole body. 

MCCLXII. 

The attacks of this difeafe are feldom at- 
tended with any fever. When the fpafms 
are general and violent, the pulfe is contract- 
ed, hurried, and irregular ; and the refpira- 
tion is afFe&ed in like manner ; But, durino- 
the remiflion, both the pulfe and respiration 
ufually return to their natural Rate. The 
heat of the body is commonly not increafed ; 

frequently 



OF PHYSIC. 19 

frequently the face is pale, with a cold fweat 
upon it ; and very often the extremities are 
cold, with a cold fweat over the whole body. 
When, however, the fpafms are frequent and 
violent, the pulie is fometimes more full and 
frequent than natural ; the face is liuihed, 
and a warm fweat is forced out over the whole 
body. 

MCCLXUI. 



Although fever be not a conflant atten 
of tins difeafe, especially when arifing from a 
lefion of nerves ; yet !e cafes proceed- 

ing from cold, a fever fometimes has fuper- 
vened, and is faid to have, been attended with 
inflammatory fymptoms.. Blood has been 
often drawn in this difeafe,. but it never ex- 
hibits any inflammatory crufl ; and all ac- 
counts feem to agree, that the blood drawn 
feems to be of a loofer texture than ordinary, 
and that it docs not coagulate in the ufual 
manner. 

MCCLXIV. 

In this difeafe the head is feldom afFecled 
with delirium, or even confufion of thought, 
till the laft flagc of it ; when, by the repeated 
fliocks of a violent diflemper, every funclioh 
of the i'y flem is greatly difordered. 

D4 CCLXVw 



20 PRACTICE 






MCCLXV. 

It is no Iefs extraordinary, that, in this vi- 
olent difeafe, the natural fun&ions are not 
cither immediately or considerably affefted. 
Vomitings fometimes appear early in the dif- 
eafe, but commonly fhey are not continued ; 
and it is ufual enough for the appetite of 
hunger to remain through the whole courfe 
of the difeafe ; and what food happens to be 
taken down, feems to be regularly enough di- 
gefted. The excretions are fometimes affect- 
ed, but not always. The urine is fometimes 
fuppreffed, or is voided with difficulty and 
pain. The belly is coftive : But, as we have 
hardly any accounts excepting of thofe cafes 
in which opiates have been largely employed, 
it is uncertain whether the coftivenefs has 
been the effeft of the opiates or of the difeafe. 
In feveral inflances of this difeafe, a miliary 
eruption has appeared upon the fkin ; but 
whether this be a fymptom of the difeafe, or 
the effeel: of a certain treatment of it, is unde- 
termined. In the mean while, it has not been 
obferved to denote either fafety or danger, or 
to have any effeel; in changing the courfe of 
the diftemper. 

MCCLXVI. 

This difeafe has generally proved fatal ; 
and this indeed may be juftly fuppofed to be 

the 



OF PHYSIC. 2i 

the confequence of its nature : But, as we 
know, that, till very lately, phyficians were 
not well acquainted with a proper method of 
cure ; and that, fince a more proper method 
has been known and praclifed, many have re- 
covered from this difeafe ; it may be therefore 
concluded, that the fatal tendency of it is not 
io unavoidable as has been imagined. .. 

In judging of the tendency of this difeafe, . 
in particular cafes, we may remark, that, when 
ariling from lefions of the nerves, it is com- 
monly more violent, and of more difficult 
cure, than when proceeding from cold ; that 
the difeafe which comes on fuddenly, and 
advances quickly to a violent degree, is al- 
ways more dangerous than that which is flow- 
er in its progrefs. Accordingly, the difeafe 
often proves fatal before the fourth day ; and, 
when a patient has paffed this period, he may 
be fuppofed to be in greater fafety, and in 
general the difeafe is the fafer the longer it 
has continued. It is, however, to be partic- 
ularly obferved, that, even for many days 
after the fourth, the difeafe continues to be 
dangerous; and even after fome confiderable 
abatement of its force, it is ready to recur 
again with its former violence and danger. 
It never admits of any fudden, or what may 
be called a crjtical folution ; but always re- 
cedes by degrees only, and it is often very 
long before the whole of the fymptoms dis- 
appear. 

Vol. 3. B5 MCCLXVII. 



PRACTICE 



MCCLXVII. 



From the hiflory of the difeafe now def- 
cribed, it will be evident, that there is no room 
for diflinguifhing the tetanus opijlhotonos, and 
trifmus or locked jazu, as different fpecies of 
this difeafe, fince "they all arife from the fame 
caufes, and are almoil conftantly conjoined 
in the fame perfon. I have no doubt that 
the emprojlhotonos belongs alfo to the fame 
genus ; and as the ancients have frequently 
mentioned it, we can have no doubt of its 
having occurred : But, at the fame time, it is 
certainly in thefe days a rare occurrence ; and, 
as I have never feen it, nor find any hiftories 
in which this particular flate of the fpafms is 
faid to have prevailed, I cannot mention the 
other circumftances which particularly attend 
it, and may diflinguifh it from the other va- 
rieties of tetanic complaints. 

MCCLXVIII. 

This difeafe has put on ftill a different form 
from any of thofe above mentioned. The 
fpafms have been fometimes confined to one 
fide of the body only, and which bend it 
ftrongly to that fide. This is what has been 
named by Sauvages the Tetanus Lateralis, 
and by fome late writers the PleuroJlhotonos.> 
This form of the difeafe has certainly appear- 
ed very feldom j and, ia any of the accounts 

given 



Or P H Y S I €. *3 

given of it, I cannot find any circumftances 
that would lead me to confider it as any other 
than a variety of the fpecies already mention- 
ed, or to take further notice of it here. 

MCCLXIX. 

V 

The pathology of this difeafe I cannot in 
any meafure attempt ; as the ftructure of 
moving fibres, the flare of them under differ- 
ent degrees of contraction, and particularly 
the (late of the fenforium, as variously deter- 
mining the motion of the nervous power, are 
all matters very imperfectly, or not at all, 
known to me. In fuch actuation, therefore, 
the endeavouring to give any rules of prac- 
tice, upon a fcientific plan, appears to me vain 
and fruitlefs", and towards directing the cure 
of this difeafe, we mull be fatisfied with hav- 
ing learned fomething ufeful from analogy, 
confirmed by experience.. 

MCCLXX. 

When the difeafe is known to arife from 
the lefion of a nerve in any part of the body, 
the firfl, and, as- 1 judge, the moft important 
ft ep to be taken towards the cure, is, by every 
poifible means to cut off that part from all 
communication with the fenforium, either by 
cutting through the nerves in their courfc, or 
perhaps by deflroying, to a certain length, 
their affetted part or extremity. 

B6 MCCLXXI. 



PRACTICE 



MCCLXXI. 

When the cure of the difeafe is to be at- 
tempted by medicine, experience has taught 
us that opium has often proved an effectual 
remedy ; but that, to render it fuch, it muft 
be given in much larger quantities than have 
been employed in any other cafe ; and in 
thefe larger quantities, it may, in this difeafe, 
be given more fafely than the body has been 
known to bear in any other condition. The 
practice has been, to give the opium either in 
a folid or a liquid form, not in any very large 
dofe at once, but in moderate dofes, frequent- 
ly repeated, at the interval of one, two, three, 
or more hours, as the violence of the fymp- 
toms feems to require. Even when large 
quantities have been given in this way, it ap- 
pears that the opium does not operate here in 
the fame manner as in mod other cafes ; for, 
though it procure fome remifTicn of the 
fpafms and pains, it hardly induces any fleep > 
or occafions that ftupor, intoxication, or de- 
lirium, which it often does in other circum- 
flances, when much fmaller quantities only 
have been given. It is therefore very prop- 
erly obferved, that, in tetanic affettions, as 
the opium (hows none of thofe eflPecls by 
which it may endanger life, there is little or 
no reafon for being fparing in the exhibition 
cf it ; and it may be given, probably fhould 

be 



OF PHYSIC. 25 

be given, as largely and as fafl as the fymp- 
toms of the difeafe may feem to demand. 

It is particularly to be obferved, that 
though the firft exhibitions of the opium may 
have produced fome remiffion of the fymp- 
toms, yet the efFecls of opium do not long 
continue in the fyftem ; and this difeafe be- 
ing for fome time ready to recur, it is com- 
monly very neceffary, by the time that the ef- 
fects of the opium given may be fuppofed to 
be wearing off, and efpecially upon the leaft 
appearance of a return of the lpafms, to re- 
peat the exhibition of the opium in the fame 
quantities as before. This practice is to be 
continued while the difeafe continues to fhow 
any difpofition to return ; and it is only after 
the difeafe has already fubfifted for fome 
time, and when confiderable and long contin- 
ued remiflions have taken place, that the dof- 
es of the opium may be diminifhed, and the 
intervals of exhibiting them be more confid- 
erable. 

MCCLXXII. 

The adminiftering of opium in this man- 
ner, has in many cafes been fuccefsful ; and 
probably would have been equally fo in 
many others, if the opium had not been too 
fparingly employed, either from the timidity 
of practitioners, or from its exhibition being 
prevented by that interruption of deglutition 
which fo often attends this difeafe. This lat- 
ter 



26 P R A C T I C E 

ter circumftance direds, that the medicine 
mould be immediately and largely employed 
upon the firft approach of the difeafe, before 
the deglutition becomes difficult ; or that, if 
this opportunity be loll, the medicine, in fuf- 
ficient quantity, and with due frequency, 
fliould be thrown into the body by glyfter ; 
which, however, does not feem to have been 
hitherto often pra&ifed. 

MCCLXXIII. 

It is highly probable, that, in this difeafe, 
the inteftines are affected with the l'pafm that 
prevails fo much in other parts of the fyftem ; 
and therefore, that coflivenefs occurs here as 
a fymptom of the difeafe. It is probably alfo 
increafed by the opium, which is here fo 
largely employed ; and, .from whichever of 
thefe caufes it arifes, it certainly mud be held 
to aggravate the difeafe, and that a relaxation 
of the inteftinal canal will contribute to a re- 
laxation of the fpafms elfewhere. This con- 
sideration directs the frequent exhibition of 
laxatives while the power of deglutition re- 
mains, or the frequent exhibition of glytlers 
when it does not ; and the good effecls of 
both have been frequently obferved. 

MCCLXXIV. 

It has been with fome probability fuppof- 
ed, that the operation of opium in this dif- 
eafe. 



OF PHYSIC. 27 

eafe, may be much aflifted by joining with it 
fome other of the moil powerful antifpafmod- 
ics. The mofl promifing are mulk and cam- 
phire ; and fome practitioners have been of 
opinion, that the former has proved very ufe- 
ful in tetanic complaints. But, whether it be 
from its not having been employed of a gen- 
uine kind, or in fufficient quantity, the great 
advantage and propriety of its ufe are not yet 
clearly alcertained. It appears to me prob- 
able, that analogous to what happens with 
refpe6l to opium, both mufk and camphire 
might be employed in this difeafe, in much 
larger quantities than they commonly have 
been in other cafes. 

MCCLXXV. 

Warm bathing hns been commonly em- 
ployed as a remedy in this difeafe, and often 
with advantage ; but, fo far as I know, it has 
not alone proved a cure • and, in fome cafes, 
whether it be from the motion of the body 
here required, exciting the fpafms, or from 
the fear of the bath, which fome perfons were 
feized with, I cannot determine ; but it is al- 
lowed, that the warm bath hath in fome cafes 
done harm, and even occafioned death. Par- 
tial fomentations have been much commend- 
ed, and, I believe, upon good grounds : And 
I have no doubt but that fomentations of the 
feet and legs, as we now ufually apply them 
in fevers, might, without much ftirring of the 

patient, 



28 PRACTICE 

patient, be very affidueufly employed with 
advantage. 

MCCLXXVI. 

Unctuous applications were very frequent- 
ly employed in this difeafe by the ancients: 
And fome modern practitioners have confid- 
ered them as very ufeful. Their effects, 
however, have not appeared to be confidera- 
ble ; and, as a weak auxiliary only, attended 
with fome inconvenience, they have been 
very much neglected by the Britifh prac- 



1 



titioners. 



MCCLXXVII. 



Bleeding has been formerly employed in 
this difeafe ; but of late it has been found 
prejudicial, excepting in a few cafes, where, 
in plethoric habits, a fever has fupervened. 
In general, the flate of men's bodies in warm 
climates is unfavourable to bloodletting ; and, 
if we may form indications from the flate of 
the blood drawn out of the veins, the ftate of 
this in tetanic difeafes would forbid bleeding 
in them. 

MCCLXXVIII. 

Bliftering alfo has been formerly employed" 
in this difeafe j but feveral practitioners affert, 

that 



OF PHYSIC. 29 

that blifters are conftantly hurtful, and they 
are now generally omitted. 

MCCLXXIX. 

Thcfe are the practices that hitherto haye 
been generally employed ; but of late we are 
informed by feveral Weftindia practitioners, 
that in many inftances they have employed 
mercury with great advantage. We are told, 
that it mull be employed early in the difeafe ; 
that it is mod conveniently adminiftered by 
unction, and mould be applied in that way 
in large quantities, fo that the body may be 
foon filled with it, and a falivation raifed, 
which is to be continued till the fymptoms 
yield. Whether this method alone be gen- 
erally fufficient for the cure of the difeafe, or 
if it may be aflifled by the ufe of opium, and 
require this in a certain meafure to be joined 
with it, I have not yet certainly learned. 

MCCLXXX. 

I have been further informed, that the te- 
tanus, in all its different degrees, has been 
cured by giving internally the PifTelceum Bar- 
badenfe, or, as it is vulgarly called, the Bar- 
badoes Tar. I think it proper to take notice 
of this here, although I am not exactly in- 
formed what quantities of this medicine are 
to be given, or in what circumftances of the 
difeafe it is moft properly to be employed, 

*MCCLXXX. 



3 G 



PRACTICE 



♦MCCLXXX. 



In the former edition of this work, among 
the remedies of tetanus I did not mention the 
ufe of cold bathing ; becaufe, though I had 
heard of this, I was not informed of fuch fre- 
quent employment of it as might confirm my 
opinion of its general efficacy ; nor was I fut- 
ficiently informed of the ordinary and proper 
adminiftrafion of it. But now, from the in- 
formation of many judicious practitioners 
who have frequently employed it, I can fay, 
that it is a remedy which in numerous trials 
has been found to be of great fervice in this 
difeafe ; and that, while the ufe of the am- 
biguous remedy of warm bathing is entirely 
laid afide, the ufe of cold bathing is over the 
whole of the Weftindies commonly employ- 
ed. The adminiftration of it is fometimes 
by bathing the perfon in the fea, or more fre- 
quently by throwing cold water from a bafon 
or bucket upon the patient's body, and over 
the whole of it : When this is done, the body 
is carefully wiped dry, wrapped in blankets, 
and laid abed, and at the fame time a large 
dofe of an opiate is given. By thefe means 
a confiderable remiflion of the fymptoms is 
obtained ; but this remiflion, at firfr, does not 
commonly remain long, but returning ao-ain 
in a few hours, the repetition both of the bath- 
ing and the opiate becomes neceffary. By 
thefe repetitions, however, longer intervals of 

cafe? 



OF PHYSIC. 3* 

cafe are obtained, and at length the difeafe is 
entireiy cured ; and this even happens fome- 
times very quickly. I have only to add, that 
it does not appear to me, from any accounts 
I have yet had, that the cold bathing has been 
fo frequently employed, or has been found fo 
commonly fuccefsful in the cafes of tetanus in 
confequence of wounds, as in thole from the 
application of cold. 

MCCLXXXI. 

Before concluding this chapter, it is proper 
for me to take fome notice of that peculiar 
cafe of the tetanus, or trifmus, which attacks 
certain infants foon after their birth, and has 
been properly enough named the Trifmus 
Nafcentium. From the fubje&s it a (Feels, it 
feems to be a peculiar difeafe : For thefe are 
infants not above two weeks, and commonly 
before they are nine days, old ; infomuch 
that, in countries where the difeafe is fre- 
quent, if children pafs the period now men- 
tioned, they are confidered as fecure againft 
its attacks. The fymptom of it chiefly taken 
notice of, is the trifmus, or locked jaw, which 
is by the vulgar improperly named the Fall- 
ing of the jaw. But this is not the only 
fymptom, as, for the mod part, it has all the 
fame fymptoms as the Opifthotonos and Te- 
tanus flriclly fo called, and which occur in 
the other varieties of tetanic complaints above 
defcribed. Like the other varieties of teta- 
nus, 



32 PRACTICE 

nus, this is mofl frequent in warm climates; 
but it is not, like thofe arifing from the appli- 
cation of cold, entirely confined to fuch warm 
climates, as inftances of it have occurred in 
moft of the northern countries of Europe. 
In thefe latter it feems to be more frequent in 
certain di Uriels than in others ; but in what 
.manner limited, I cannot determine. It 
feems to be more frequent in Swat Zetland than 
in France. I am informed of its frequently 
occurring in the Highlands of Scotland • but 
I have never met with any inflance of it in 
the low country. The particular caufes of it 
are not well known ; and various conjectures 
have been offered ; but none of them are fat- 
isfying. It is a difeafe that has been almoft 
-conflantly fatal ; and this, alfo, commonly in 
the courfe of a few days. The women are fo 
much perfuaded of its inevitable fatality, that 
they feldom or never call for the affiftance of 
our art. This has occafioned our being link 
acquainted with the hiftory of the difeafe, or 
with the effe&s of remedies in it. Analogy, 
however, would lead us to employ the fame 
remedies that have proved ufeful in the other 
cafes of tetanus ; and the few experiments 
that are yet recorded, feem to approve of. 
fuch a practice. 



Chap. 



OF PHYSIC. 33 

C II A P. II. 

-Of Epilepsy. 

MCCLXXXII. 

IN what fenfe I ufe the term ConvulJion> I 
have explained above in MCCLVI. 

The convulfions that affecl; the human 
body are in feveral refpe&s various ; but I 
am to confider'here only the chief and mod 
frequent form in which they appear, and 
which is in the difeafe named Epikpfy. This 
may be defined, as confiding in convulfions 
of the greater part of the mufcles of voluntary 
motion, attended with a lofs of fenfe, and 
ending in a (late of infenfibility and feeming 
fleep. 

MCCLXXXIIL 

The general form or principal circum-*- 
frances of this difeafe, are much the fame in 
all the different perfons whom it affects. It 
Comes by fits, which often attack perfons 
feemingly in perfect health ; and, after lad- 
ing for fome time, pafs off, and leave the per- 
fons again in their ufual date* Thefe fits are 

fometimes 




34 PRACTICE 

fometimes preceded by certain fymptoms, 
which, to perfons who have before experienc. 
cd fuch a fit, may give notice of its approach, 
as we fha!l hereafter explain ; but even thefe 
preludes do not commonly occur long before 
the formal attack, which in mofl cafes comes 
on fuddenly without any fuch warning. 

The perfon attacked lofes fuddenly all fenfe 
and power of motion ; fo that, if {landing, he 
falls immediately, or perhaps, with convul- 
fions, is thrown to the ground. In that fit- 
nation he is agitated with violent convulfions, 
variously moving his limbs and the trunk of 
his body. Commonly the limbs on one fide 
of the body, are more violently or more con- 
fiderably agitated than thofe upon the other. 
In all cafes the mufcles of the face and eyes 
are much affected, exhibiting various and vi- 
olent diftortions of the countenance. The 
tongue is often affected, and thruft out of the 
mouth; while the mufcles of the lower jaw 
are alfo affected ; and, fhutting the mouth 
with violence while the tongue is thruft out 
between the teeth, that is often grievoufly 
wounded. 

While thefe convulfions continue, there is 
commonly at the fame time a frothy moiflure 
iffuing from the mouth. Thefe convulfions 
have for fome moments fome remifTions, but 
are fuddenly again renewed with great vio- 
lence. Generally, after no long time, the 
convulfions ceafe altogether ; and the perfon 
for fome time remains without motion, but in 

a ftate 






a Mate of abfolute infenhbility, and under the 
appearance of a profound fleep. After fome 
continuance of this feeming deep, the perfon 
ibmetimes fuddenly, but for the moll part by 
degrees only, recovers his fenfes and power of 
motion ; but without any memory of what 
had paired from his being nrft feized with 
the fit. During the convulfions, the pulfe 
and refpiration are hurried and irregular ; 
but, when the convulfions ceafie, they return 
to their ufual regularity and healthy date. 

This is the general form of the difeafe ; and 
it varies only in different perfons, or on dif- 
ferent occafions in the fame perfon, by the 
phenomena mentioned being more or lefs vi- 
olent, or by their being of longer or fhorter 
duration. 

MCCLXXXIV. 

With refpecl to the proximate caufe of this 
difeafe, I might fay, that it is an affe&ion of 
the energy of the brain, which, ordinarily un- 
der the direction of the will, is here, without 
any concurrence of it, impelled by preternat- 
ural caufes. But I could go no farther : For, 
as to what is the mechanical condition of the 
brain in the ordinary exertions of the will, I 
have no diftinft knowledge; and therefore 
muft be alio ignorant of the preternatural 
flate of the fame energy of the brain under* 
the irregular motions here produced. To 
form, therefore, the indications of a cure, from 

a knowledge 



36 PRACTICE 

a knowledge of the proximate caufe of tins 
difeafe, I muft not attempt ; but, from a dili- 
gent attention to the remote caufes which firfl: 
induce and occafionally excite the difeafe, I 
think we may often obtain fome ufeful direc- 
tions for its cure. It ftiall therefore be my 
bufmefs now, to point out and enumerate 
thefe remote caufes as well as I can. 

MCCLXXXV. 

The remote caufes of epilepfy may be con* 
fidered as occafional or predifponent. There 
are, indeed, certain remote caufes which aft 
independently of any predifpofition ; but, as 
we cannot always diflinguifh thefe from the 
others, I fliall confider the whole under the 
ufual titles of Occafwnal or Predifponent. 

MCCLXXXVI. 

The occafional caufes may, I thinly be 
properly referred to two general heads ; the 
jirji being of thofe which feem to a£t. by di- 
rectly ftimulating and exciting the energy of 
the brain ; and the fecond, of thofe which 
ieem to acl; by weakening the fame. With 
refpecl: to both, for the brevity of cxpreffiiV a 
fact, without meaning to explain the manner 
in which it is brought about, I fhall ufe the 
terms of Excitement and Collapfe. And 
though it be true, that with refpect to fome 
of the caufes I am to mention, it may be a 

little 



OF PHYSIC. 37 

lLtle uncertain whether they act in the one 
way or the other, that does not render it im- 
proper for us to mark, with refpect to others, 
the mode of their operating, wherever we can 
do it clearly, as the doing lb may often be of 
ufe in directing our practice. 

MCCLXXXVII. 

Firit, then, of the occafional caufes acting 
by excitement : They are either fuch as act 
immediately and directly upon the brain it- 
felf ; or thofe which are firfl applied to the 
other parts of the body, and are from thence 
communicated to the brain. 

MCCLXXXVIII. 

The caufes of excitement immediately and 
directly applied to the brain, may be referred 
to the four heads of, 1. Mechanical Stimu- 
lants ; 2. Chemical Stimulants ; 3. Mental 
Stimulants ; and, 4. The peculiar Stimulus 
of Over Diftention. 

MCCLXXXIX. 

The mechanical ftimulants may be, wound- 
ing inftruments penetrating the cranium, and 
entering the fubftance of the brain ; or Iplin- 
ters of a fractured cranium, operating in the 
fame manner ; or fharp pointed ofiifications, 
either arifing from the internal furface of the 

Vol. III. C cranium. 



.8 PRACTICE 

o 

cranium, or formed in the membranes of the 
brain. 

MCCXC. 

Thechemicalftimulants(MCCLXXXVIII) 
may be fluids from various caufes lodged in 
certain parts of the brain, and become acrid 
by ftagnation or otherwife. 

MCCXCI. 

The mental irritations acting by excite- 
ment, are, all violent emotions of the active 
kind, fuch as joy and anger. The firft of 
thefe is manifeftly an exciting power, a6ting 
ftrongly, and immediately, on the energy of 
the brain. The fecond is manifeftly, alfo, a 
power acting in the fame manner. But it 
Tnuft be remarked, that it is not in this man- 
ner alone anger produces its effects : For it 
acts, alfo, ftrongly on the fanguiferous fyftem, 
and may be a means of giving the itimulus of 
over diftcntion ; as, under a fit of anger, the 
blood is impelled into the veffels of the head 
with violence, and in a larger quantity. 

MCCXCII. 

Under the head of Mental Irritations, is to 
^be mentioned, the fight of perfons in a fit of 
epilepfy, which has often produced a fit of the 
like kind in the fpectator. It may, indeed, be 

a queftion, 



OF P H Y S I C. 39 

a queftion, Whether this effect be imputable 
to the horror produced by a fight of the feem- 
ingly painful agitations of the limbs, and of 
the diltortions in the countenance of the epi- 
leptic perfon ; or if it may be afcribed to the 
force of imitation merely ? It is poflible, that 
horror may fometimes produce the effect. : 
But certainly much may be imputed to that 
propenfity to imitation, at all times fo power- 
ful and prevalent in human nature ; and fo 
often operating in other cafes of convulfivc 
diforders, which do not prefent any fpettaclc 
of horror. 

MCCXCIII. 

Under the fame head of Mental Irritation, 
I think proper to mention as an inflance of it, 
the Epilepfia Simulata, or the Feigned Epi- 
lepfy, fo often taken notice of. Although 
this, at firft, may be entirely feigned, I have 
no doubt but that the repetition renders it at 
length real. The hiftory of Quietifm and of 
Exorcifms leads me to this opinion ; and 
which receives a confirmation from what we 
know of the power of imagination, in renew- 
ing epileptic and hyfteric fits. 

MCCXCIV. 

I come now to the fourth head of the irri- 
tations applied immediately to the brain, and 
which I apprehend to be that of the Over Dif- 
C £ tention 



40 PRACTICE 

tention of the bloodveflels in that organ, 
That fuch a caufe operates in producing epi- 
lepfy, is probable from this, that the diflection 
of perfons dead of epilepfy, has commonly 
discovered the marks of a previous congeflion 
in the bloodveflels of the brain. This, per- 
haps, may be fuppofed the effect of the fit 
which proved fatal : But that the congeflion 
was previous thereto, is probable from the 
epilepfy being fo often joined with headach, 
mania, palfy, and apoplexy ; all of them, dif- 
eafes depending upon a congeflion in the 
vefTels of the brain. The general opinion 
receives alfo confirmation from this circum- 
ftance, that, in the brain of perfons dead of 
epilepfy, there have been often found tumours 
and effufions, which, though feemingly not 
fufficient to produce thofe difeafes which de- 
pend on the compremon of a confiderable- 
portion of the brain, may, however,' have 
"been fufficient to comprefs fo many veffels as 
to render the others upon any occafion of a 
more than ufual turgefcence, or impulfe of 
the blood into the veffels of the brain more 
liable to an over diflention. 

MCCXCV. 

Thefe confide'rations alone might afford 
foundation for a probable, conjecture with 
refpect to the effects of over diflention. But 
the opinion does not refl upon conjecture 
alone. That it is alfo founded in fact, ap- 
pear* 



OF PHYSIC. 41 

pears from hence, that a plethoric (late is fa- 
vourable to epilepfy ; and that every occa- 
sional turgefcence, or unufual impulfe of the 
blood into the veifels of the brain, fuch as a 
fit of anger, the heat of the fun, or of a warm 
chamber, violent exercife, a Surfeit, or a fit of 
intoxication, are frequently the immediately 
exciting caufes of epileptic fits* 

MCCXCVI. 

I venture to remark further, that a piece of 
theory may be admitted as a confirmation of 
this doctrine. As I have formerly maintain- 
ed, that a certain fulnefs and tenfion of the 
vellels of the brain is neceffary to the fupport 
of its ordinary and conflant energy, in the 
distribution of the nervous power ; fo it rnufl 
be Sufficiently probable, that an over disten- 
tion of thefe bloodveffels may be a caufe of 
violent excitement. 

1 MCCXCVII. 

We have now enumerated the Several re- 
mote or occafional caufes of epilepfy, acting 
bv excitement, and acting immediately upon 
the brain itfelf. Of the caufes acting by ex- 
citement, but acting upon other parts of the 
body, and from thence communicated to the 
brain, they are all of them impreffions pro- 
ducing an exquiSite or high degree either of 
pleafure or pain. 

C 3 Impreffions 



4 2 



PRACTICE 



Impreffions which produce neither the one 
nor the other, have hardly any fueh effecls ; 
unlefs when fuch impreffions are in a violent 
degree, and then their operation may be con- 
fidered as a mode of pain. It is, however,. to 
be remarked, that all [hong impreffions which 
are fudden and furprifing, or, in other words, 
unforefeen and unexpected, have frequently 
the effeft of bringing on epileptic fits. 

MCCXCVIII. 

There are certain impreffions made upon 
different parts of the body, which as they 
often operate without producing any fenfa- 
tion, fo it is uncertain to what head they be- 
long : But it is probable that the greater part 
of them acl by excitement, and therefore fall 
to be mentioned here. The chief inftances 
are, The teething of infants ; worms ; acidity 
or other acrimony in the alimentary canal ; 
calculi, in the kidneys ; acrid matter in ab- 
fcefles or ulcers ; or acrimony diffufed in the 
mafs of blood, as in the cafe of fome conta- 
gions. 

MCCXCIX. 

Phyficians have found no difficulty in 
comprehending how direel flimulants, of a 
certain force, may excite the aclion of the 
brain, and occafion epilepfy ; but they have 
hitherto taken little notice of certain caufes 

which 



OF PHYSIC. 43 

which manifeftly weaken the energy of the 

brain, and aft, as I fpeak, by collapfe. 

Thefe, however, have the effect of exciting 

the action of the brain in fuch a manner as to 

occafion epilepfy. I might, upon this fub- 

ject, fpeak of the vis medicatrix nature ; and 

there is a foundation for the term : But, as I 

do not admit the Stahlian doctrine of an ad- 

miniftering foul, I make ufe of the term only 

as expreflinga fact, and would not employ it 

with the view of conveying an explanation of 

the manner in which the powers of collapfe 

mechanically produce their effects. In the 

mean time, however, I maintain, that there 

are certain powers of collapfe, which in effect 

prove flimulants, and produce epilepfy. 

MCCC. 

That there are fuch powers, which may be 
termed Indirect Stimulants, I conclude from 
hence, that feveral of the caufes of epilepfy 
are fuch as frequently produce fyncope, 
which we fuppofe always to depend upon 
caufes weakening the energy of the brain 
(MCLXXVI). It may give fome difficulty 
to explain, why the fame caufes fometimes 
occafion fyncope, and fometimes occafion the 
reaction that appears in epilepfy ; and I fhall 
not attempt to explain it : But this, I think, 
does not prevent my fuppofing that the ope- 
ration of thefe caufes is by collapfe. That 
there are fuch caufes producing epilepfy, will, 
C 4 I think, 






44 P R A C T I C E 

I think, appear very clearly from the partic- 
ular examples of them. I am now to mention. 

MCCCI. 

The firft to be mentioned, which I fuppofe 
to be of this kind, is hemorrhagy, whether 
fpontaneous or artificial. That the fame he- 
morrhagy which produces fyncope,. often at 
the fame time produces epilepfy, is well 
known - T and from many experiments and 
obfervations it appears, that hemorrhagies oc- 
curring to fuch a degree as to prove mortal,, 
feldom do fo without firfl producing epilepfy, 

MCCCII. 

Another caufe a&ing, as I fuppofe, by col- 
lapfe, and therefore fometimes producing fyn- 
cope and fometimes epilepfy, is terror ; that 
is, the fear of fome great evil fuddenly prefent- 
ed. As this produces at the fame time a fud- 
den and confiderable emotion, (MCLXXX), 
fo it more frequently produces epilepfy thari 
fyncope. 

MCCCIII. 

A third caufe atting by collapfe, and pro- 
ducing epilepfy, is horror ; or a flrong aver- 
fion fuddenly raifed by a very dilagreeable 
fenfation, and frequently arifing from a fym- 
pathy with the pain or danger of another per- 

fon. 



OF PHYSIC. 45 

fon. As horror is often a caufe of fyncope, 
there can be no doubt of its manner of ope- 
rating in producing epilepfy ; and it may 
perhaps be explained upon this general prin- 
ciple, That as defire excites action and gives 
activity, fo averfion re f trains from action, that 
is, weakens the energy of the brain ; and, 
therefore, that the higher degrees of averlion 
may have the effe&s of producing fyncope or 
epilepfy. 

MCCCIV. 

A fourth fet of the caufes of epilepfy, 
which I fuppofe alfo to a£t by collapfe, are 
certain odours, which occafion either fyncope 
or epilepfy ; and, with refpe6t to the former, 
I have given my reafons (MCLXXXII) for 
fuppofing odours in that cafe to act rather as 
difagreeable than as fedative. Thefe reafons 
will, I think, alfo apply here ; and perhaps 
the whole affair of odours might be confider- 
ed as inftances of the efFecl: of horror, and 
therefore belonging to the laft head. 

fMCCCV. 

A fifth head of the caufes producing epi- 
lepfy by collapfe, is the operation of many 
fubftances confidered, and for the molt part 
properly confidered, as poifons. Many of 
thefe, before they prove mortal, occafion epi- 
lepfy. This effect, indeed, may in fome cafes 
be referred to the inflammatory operation 

Vol. 3. C 5 which 



^o PRACTICE 

which they fometimes difcover in the ftomach 
and other parts of the alimentary canal ; bur, 
as the greater part of the vegetable poifons 
fhow chiefly a narcotic, or ftrongly fedative 
power, it is probably by this power that they 
produce epilepfy, and therefore belong to this 
head of the caufes acting by collapfe. 

MCCCVI. 

Under the head of the remote caufes pro- 
ducing epilepfy, we muft now mention that 
peculiar one whofe operation is accompanied 
with what is called the Aura Epileptica. 
This is a fenfation of fomething moving in 
fame part of the limbs or trunk of the body, 
and from thence creeping upwards to the 
head ; and when it arrives there, the perfon 
is immediately deprived of fenfe, and falls in- 
to an epileptic fit. This motion is defcribed 
by the perfon's feeling it fometimes as a cold 
vapour, fometimes as a fluid gliding, and 
fometimes as the fenfe of a fmall infect creep- 
ing along their body ; and very often they 
can give no diftincl: idea of their fenfation, 
otherwife than as in general of fomething 
moving along. This fenfation might be fup- 
pofed to arife from fome affection of the ex- 
tremity or other part of a nerve a£ted upon 
by fome irritating matter ; and that the fen- 
fation, therefore, followed the courfe of fuch 
a nerve : But I have never found it following 
diilin&ly the courfe of any nerve ; and it 

generally 



OF PHYSIC. 47 

generally feems to pafs along the teguments. 
It has been found in fome lnftances to arife 
from fomething preffing upon or irritating a 
particular nerve, and that fometimes in con- 
fequence of contufion or wound : Bat in- 
fiances of thefe are more rare ; and the more 
common confequence of contufions and 
wounds is a tetanus. This latter effect 
wounds produce, without giving any fenfa- 
tion of an aura or other kind of motion pro- 
ceeding from the wounded part to the head ; 
while, on the other hand, the aura producing 
epilepfy often arifes from a part which had 
never before been affe&ed with wound or con- 
tufion, and in which part the nature of the 
irritation can feldom be difcovered. 

It is natural to imagine that this aura epi- 
leptica is an evidence of fome irritation or di- 
re£l flimulus atling in the part, and from 
thence communicated to the brain, and fhould 
therefore have been mentioned amongr the 
caufes a£iing by excitement ; but the re- 
markable difference that occurs in feemingly 
like caufes producing tetanus, gives fome 
doubt on this fubje£t. 

MCCCVII. 

Having now enumerated the occafional 
caufes of epilepfy, I proceed to confider the 
predifponent. As fo many of the above 
mentioned caufes a6t. upon certain perfons, 
and not at all upon others, there mult be fup- 
C 6 pofed 



4 8 PRACTICE 

pofed in thofe perfons a predifpofition to this 
Uifeafe : But in what this predifpofition con- 
fids, is not to be eafily afcertained. 

MCCCVIII. 

As many of the occafional caufes are weak 
impreflions, and are applied to moft perfons 
with little or no effett, I conclude, that the 
perfons affe&ed by thofe caufes are more ea- 
fily moved than others ; and therefore, that, 
in this cafe, a certain mobility gives the pre- 
difpofition. It will, perhaps, make this mat- 
ter clearer, to fhow, in the firft place, that 
there is a greater mobility of conflitution in 
fome perfons than in others. 

MCCCIX. 

This mobility appears moil clearly in the 
ftate of the mind. If a perfon is readily elat- 
ed by hope, and as readily depreffed by fear, 
and paffes eafily and quickly from the one 
ftate to the other ; if he is eafily pleafed, and 
prone to gaiety, and as eafily provoked to 
anger, and rendered peevifh ; if liable, from 
flight impreflions, to flrong emotions, but te- 
nacious of none ; this is the boyifh tempera- 
ment, qui colligit ac ponit tram temere, et mu- 
tator in horas ; this is the variwm et mutabih 
Jxmina ; and, both in the boy and woman 
every one perceives and acknowledges a mo- 
bility of mind. But this is neceffanly con- 
nected 



OF PHYSIC. 49 

necled with an analogous flate of the brain ; 
that is, with a mobility, in refpe6fc of every 
impreflion, and therefore liable to a ready al- 
ternation of excitement and collapfe, and of 
both to a confiderable degree. 

MCCCX. 

■ 

There is, therefore, in certain perfons, a 
mobility of conftitution, generally derived 
from the flate of original ftamina, and more 
exquifite at a certain period of life than at 
others ; but fometimes arifing from, and par- 
ticularly modified by, occurrences in the 
courfe of life. 

MCCCXI. 

This mobility conn its in a greater degree 
of either fenfibility or irritability. Thefe 
conditions, indeed, phyficians confider as fo 
neceflarily connected, that the conftitution 
with refpecl: to them, may be confidered as 
one and the fame : But I am of opinion that 
they are different ; and that mobility may 
fometimes depend upon an increafe of the 
one, and fometimes on that of the other. If 
an action excited, is, by repetition, rendered 
more eafily excited, and more vigoroufly per- 
formed, I confider this as an increafe of irri- 
tability only. I go no farther on this fubjecl; 
here, as it was only neceffary to take notice 
of the cafe juft now mentioned, for the pur- 

pofe 



5 c* PRACTICE 

pofe of explaining why epilepfy, and convul- 
lions of all kinds, by being repeated, are more 
eafily excited, readily become habitual, and 
are therefore of more difficult cure. 

MCCCXII. 

However we may apply the diftinttion of 
fenfibility and irritability, it appears that the 
mobility, which is the predifponent caufe of 
epilepfy, depends more particularly upon de- 
bility, or upon a plethoric date of the body. 

MCCCXIII. 

What fhare debility, perhaps by inducing 
fenfibility, has in. this matter, appears clearly 
from hence, that children, women, and other 
perfons of manifefl debility, are the moll fre- 
quent fubjecls of this difeafe. 

MCCCXIV. 

The effetts of a plethoric ft ate in difpofing 
to this difeafe appears from hence, that ple- 
thoric perfons are frequently the fubjecls of it : 
That it is commonly excited, as 1 have faid 
above, by the caufes of any unufual turgel- 
cence of the blood ; and that it has been fre- 
quently cured by diminiihing the plethoric 
ftate of the body. 

That a plethoric ftate of the body fhould 
difpofe to this difeafe, we may under ftand 

from 



OF PHYSIC. 51 

from feveral confide rat ions, ljl, Becaufe a 
plethoric ftate implies, for the molt part, a 
laxity of the folids, and therefore fome debil- 
ity in the moving fibres. 2dly, Becaufe, in 
a plethoric ftate, the tone of the moving fi- 
bres depends more upon their tenfion, than 
upon their inherent power : And as their ten- 
fion depends upon the quantity and impetus 
of the fluids in the bloodveffels, which are 
very changeable, and by many caufes fre- 
quently changed, fo thefe frequent changes 
mull give a mobility to the fyftem. §dly t 
Becaufe a plethoric ftate is favourable to a 
congeftion of blood in the velfels of the brain, 
it mult render thefe more readily affe&ed by 
every general turgefcence of the blood in the 
fyftem, and therefore more efpecially difpofo 
to this difeafe. 

MCCCXV. 

There is another circumftance of the body 
difpofing to epi'epfy, which I cannot fo well 
account for ; and that is, the ftate of fleep : 
But whether I can account for it or not, it 
appears, in fatt, that this ftate gives the dif- 
pofition I fpeak of ; for, in many perfons lia- 
ble to this difeafe, the fits happen only in the 
time of fleep, or immediately upon the per- 
son's coming out of it. In a cafe related by 
De Haen, it appeared clearly, that the difpo- 
fition to epilepfy depended entirely upon the 
ftate of the body in deep. 

MCCCXVI. 



5* 



PRACTICE 



MCCCXVI. 



Having thus confidered the whole of the 
remote caufes of epilepfy, I proceed to treat 
of its cure, as I have laid it is from the con- 
fideration of thofe remote caufes only that we 
can obtain any directions for our practice in 
this difeafe. 

I begin with obferving, that as the difeafe 
may be confidered as fympathic or idiopathic, 
I muft treat of thefe feparately, and judge it 
proper to begin with the former. 

MCCCXVII. 

When this difeafe is truly fympathic, and 
depending upon a primary affection in fome 
other part of the body, fuch as acidity or 
worms in the alimentary canal, teething, or 
other fimilar caufes, it is obvious, that fuch 
primary affections muff be removed for the 
cure of the epilepfy ; but it is not our bufi- 
nefs here to fay how thefe primary difeafes 
are to be treated. 

MCCCXVIII. 

There is, however, a peculiar cafe of fym- 
pathic epilepfy ; that is, the cafe accompa- 
nied with the aura epileptica, as defcribed in 
MCCCVI, in which, though we can perceive 
by the aura epileptica arifing from a particu- 
lar 



OF PHYSIC. 53 

]ar part, that there is fome affection in that 
part ; yet, as in many fuch cafes we cannot 
percaive of what nature the affection is, I can 
only offer the following general directions. 

1/?, When the part can with fafety be en- 
tirely deftroyed, we mould endeavour to do 
fo by cutting it out, or by deftroying it by 
the application of an actual or potential 
cautery. 

idly, When the part cannot be properly 
deftroyed, that we ihould endeavour to cor- 
reft the morbid affection in it by Wittering, or 
by eftablifhing an iffue upon the part. 

$dly t When thefe meafures cannot be exe- 
cuted, or do not fucceed,. if the difeafe feem« 
to proceed from the extremity of a particular 
nerve which we can eafily come at in its 
courfe, it will be proper to cut through that 
nerve, as before propofed on the fubject of 
tetanus. 

4thly t When it cannot be perceived that 
the aura arifes from any precife place or 
point, fo as to direct to the above mentioned 
operations \ but, at the fame time, we can 
perceive its progrefs along the limb ; it fre- 
quently happens that the epilepfy can be pre- 
vented by a ligature applied upon the limb, 
above the part from which the aura arifes : 
And this is always proper to be done, both 
becaufe the preventing a fit breaks the habit 
of the difeafe, and becaufe the frequent com- 
preflion renders the nerves lefs fit to propa- 
gate the aura. 

MCCCXIX. 



54 



PRACTICE 



MCCCXIX. 



The cure of idiopathic epilepfy, as I have 
faid above, is to be directed by our knowledge 
of the remote caufes. There are therefore 
two general indications to be formed : The 
jfirft is, to avoid the occafional caufes ; and 
the fecond is, to remove or correct the pre- 
difponent. 

This method, however, is not always pure- 
ly palliative ; as in many cafes the prcdifpo- 
nent may be confidered as the only proximate 
caufe, fo our fecond indication may be often 
confidered as properly curative. 

MCCCXX. 

From the enumeration given above, it will 
be manifeft, that for the moll part the occa- 
fional caufes, fo far as they are in our power, 
need only to be known, in order to be avoid- 
ed ; and the means of doing this will be fuf- 
ficiently obvious. I fhall here, therefore, of- 
fer only a few remarks. 

MCCCXXI. 

One of the mod frequent of the occafional 
caufes is that of oyer diftention (MCCCXIV), 
which, fo far as it depends upon a plethoric 
ftate of the fyftem, I fhall fay hereafter how 
it is to be avoided. But as, not only in the 

plethoric, 



OF PHYSIC. 55 

plethoric, but in every moveable conftitution, 
occafional turgefcence is a frequent means 
of exciting epilepfy, the avoiding therefore 
of fuch turgefcence is what ought to be 
moft conftantly the object of attention to per- 
sons liable to epilepfy. 

MCCCXXII. 

Another of the moft frequent exciting cauf- 
fs of this difeafe are, all flrong impreflions 
fuddenly made upon the fenfes ; for as fuch 
impreflions, in moveable conftitutions, break 
in upon the ufual force, velocity, and order 
of the motions of the nervous fyilem, they 
thereby readily produce epilepfy. Such im- 
preflions therefore, and efpecialiy thofe which 
are fuited to excite any emotion or paflion of 
the mind, are to be moft carefully guarded 
againft by perfons liable to epilepfy. 

MCCCXXIII. 

In many cafes of epilepfy, where the pre- 
difponent caufe cannot be corrected or re- 
moved, the recurrence of the difeafe can only 
be prevented, by the flricleft attention to 
avoid the occafional ; and as the difeafe is 
often confirmed by repetition and habit, fo 
the avoiding the frequent recurrence of it is 
of the utmoft importance towards its cure. 

Thefe are the few remarks I have to offer 
with refpecl to the occafional caufes ; and 

mull 



5 6 PRACTICE 

muft now obferve, that, for the mofl part, the 
complete, or, as it is called, the Radical Cure, 
is only to be obtained by removing or cor- 
recting the predifponent caufe. 

MCCCXXIV. 

i 

I have faid above, that the predifponent 
caufe of epilepfy is a certain mobility of the 
fenforium j and that this depends upon a 
plethoric flate of the fyflem, or upon a .cer- 
tain Hate of debility in it. 

MCCCXXV. 

How the plethoric flate of the fyflem is to 
be corrected, I have treated of fully above in 
DCCLXXXIII etfeq. and I need not re- 
peat it here. It will be enough to fay, that it 
is chiefly to be done by a proper manage- 
ment of exercife and diet ; and, with refpect 
to the latter, it is particularly to be obferved 
here, that an abflemious courfe has been fre- 
quently found to be the mofl certain means 
of curing epilepfy. 

MCCCXXVI. 

Confidering the nature of the matter pour- 
ed out by iffues, thefe may be fuppofed to be 
a conftant means of obviating the plethoric 
flate of the fyflem ; and it is, perhaps, there- 
fore, that they have been fo often found ufe- 

ful 



O F P H Y S I C. 57 

ful in epilepfy. Poffibly, alfo, as an open 
iffue may be a means of determining occasion- 
al turgefcences to fuch places, and therefore 
of diverting them in fome meafure from their 
action upon the brain ; io alfo, in this man- 
ner, iffues may be ufeful in epilepfy. 

MCCCXXVII. 

It might be fuppofed that bloodletting 
would be the moft effectual means of correct- 
ing the plethoric ftate of the fyftem ; and 
fuch it certainly proves when the plethoric 
Hate has become confiderable, and imme- 
diately threatens morbid effects. It is there- 
fore, in fuch circumflances, proper and necef- 
fary : But as we have faid above, that blood- 
letting is not the proper means of obviating a 
recurrence of the plethoric ftate, and, on the 
contrary, is often the means of favouring it ; 
fo it is not a remedy advifable in every cir- 
cumflance of epilepfy. There is, however, a 
cafe of epilepfy in which there is a periodical 
or occasional recurrence of the fulnefs and 
turgefcence of the fanguiferous fyftem, giving 
occafion to a recurrence of the difeafe. In 
fuch cafes, when the means of preventing 
plethora have been neglected, or may have 
proved ineffectual, it is absolutely neceffary 
for the practitioner to watch the returns of 
thefe turgefcences, and to obviate their effects 
by the only certain means of doing it, that is, 
by a large bloodletting. 

MCCCXXVIIL 



58 PRACTICE 

MCCCXXVIII. 

The fecond caufe of mobility which we 
have affigned, is a flate of debility. If this is 
owing, as it frequently is, to original con- 
formation, it is perhaps not poflibie to cure 
it ; but v/hen it has been brought on in the 
courfe of life, it poflibly may admit of being 
mended ; and, in either cafe, much may be 
done to obviate and prevent its effects. 

MCCCXXIX. 

The means of correcting debility, fo far as 
it can be done, are, The perfon's being much 
in cool air ; the frequent ufe of cold bath- 
ing ; the ufe of exercife, adapted to the 
ftrength and habits of the perfon ; and, per* 
haps, the ufe of aflringent and tonic medi- 
cines. 

Thefe remedies are fuited to ftrengthen the 
inherent power of the folids or moving fibres : 
But as the ftrength of thefe depends alfo up- 
on their tenfion, fo when debility has pro- 
ceeded from inanition, the ftrength may be 
reftored, by reftoring the fulnefs and tenfion 
of the veUfils by a nourifhing diet ; and we 
have had inftances of the propriety and fuc* 
cefs of fuch a practice. 

MCCCXXX. 



O F P H Y S I C. 59 



MCCCXXX. 

The means of obviating the effe&s of de- 
bility, and of the mobility depending upon 
it, are the ufe of tonic and antifpafmodic rem- 
edies. 

The tonics are, Fear, or fome degree of 
terror ; aftringents ; certain vegetable and 
metallic tonics ; and cold bathing. 

MCCCXXXI. 

That fear, or fome degree of terror, may 
be of ufe in preventing epilepfy, we have a 
remarkable proof in Boerhaave's cure of the 
opilepfy, which happened in the Orphan- 
houfe at Haerlem. See Kauu Boerhaave's 
treatife, entitled Impetum Faciens, § 406. And 
Ave have met with feveral other inftances of 
the fame. 

As the operation of horror is in. many ref- 
pe&s analogous to that of terror, feveral feem- 
ingly fuperflitious remedies have been em- 
ployed for the cure of epilepfy ; and, if they 
have ever been fuccefsful, I think it muft be 
imputed to the horror they had infpired. 

MCCCXXXII. 

Of the aflringent medicines ufed for the 

'cure of epilepfy, the moft celebrated is the 

vifcus quercinu$ t which, when given in large 

quantities, 



6o PRACTICE 

quantities, may poffibly be ufeful ; but I be- 
lieve it was mote efpecially fo in ancient 
times, when it was an objecl of fuperftition. 
In the few inftances in which I have feen it 
employed, it did not prove of any effecT:. 



MCCCXXXIII. 



Among the vegetable tonics, the bitters arc 
to be reckoned ; and it is by this quality that 
I fuppofe the orange tree leaves to have been 
ufeful : JButthey are rtotal ways fo. 



MCCCXXXIV- 



The vegetable tonic, which from its ufe in 
-analogous cafes is the moft promifing, is the 
Peruvian bark ; this, upon occafion, has been 
ufeful, but has alfo often failed. It is efpec- 
ially adapted to thofe epilepfies which recur 
at certain periods, and which are at the fame 
time without the recurrence of any plethoric 
ftate, or turgefcence of the blood ; and in 
fuch periodical cafes, if the bark is employed 
fome time before the expected recurrence, it 
may be ufeful : But it muft be given in large 
quantity, and as near to the time of the ex- 
pected return as poffible. 

MCCCXXXV. 



OF PHYSIC. 6i 



MCCCXXXV. 

The metallic tonics feem to be more pow- 
erful than the vegetable, and a great variety 
of the former have been employed. 

Even arfenic has been employed in the 
cure of epilepfy ; and its ufe in intermittent 
fevers gives an analogy in its favour. 

Preparations of tin have been formerly rec- 
ommended in the cure of epilepfy, and in the 
cure of the analogous difeafe of hyfteria ; and 
feveral confiderations render the virtues of 
tin, with refpecl; to thefe difeafes, probable : 
But I have had no experience of its ufe in 
fuch cafes. 

A much fafer metallic tonic is to be found 
in the preparations of iron ; and we have 
feen fome of them employed in the cure of 
epilepfy, but have never found them to be 
effectual. This, however, I think, may be 
imputed to their not having been always em- 
ployed in the circumftances of the difeafe, 
and in the quantities of the medicine, that 
were proper and neceflary. 

MCCCXXXVI. 

Of the metallic tonics, the moll celebrated 
and the moft frequently employed is copper, 
under various preparation. What prepara- 
tion of it may be the moft effectual, I dafe 

Vol. III. D not 



62 PRACTICE 

not determine ; but of late the cuprum am- 
nnoniacum has been frequently found fuc- 
cefsful. 

MCCCXXXVII. 

Lately the flowers of zinc have been rec^ 
ommended by a great authority as ufeful in 
all convulfive diforders ; but in cafes of epi* 
lepfy, I have not hitherto found that medicine 
ufeful. 

MCCCXXXVIII. 

There have been of late fome inftances of 
the cure of epilepfy by the accidental ufe of 
mercury ; and if the late accounts Of the cure 
of tetanus by this remedy are confirmed, it 
will allow us to think that the fame may be 
adapted alfo to the cure of certain cafes of 
epilepfy. 

MCCCXXXIX. 

With refpecl; to the employment of any of 
the above mentioned tonics in this difeafe, it 
muft be obferved, that in all cafes where the 
difeafe depends upon a conflant or occafional 
plethoric ftate of the fyftem, thefe remedies 
are likely to be ineffeclual ; and if fufficient 
evacuations are not made at the fame time, 
thefe medicines are likely to be very hurtful. 

MCCCXL; 



O F P II Y S i C. 63 



MCCCXL. 

The other fet of medicines which we have 
^mentioned as fuited to obviate the effects of 
the too great mobility of the fyflem, are the 
medicines named antifpafmodics. Of thefe 
there is a long lift in the writers on the Ma- 
teria Medica, and by thefe authors recom- 
mended for the cure of epilepfy. The great- 
er part, however, of thofe taken from the veg- 
etable kingdom, are manifeftly inert and in- 
fignificant. Even the root of the wild vale- 
rian hardly fupports its credit. 

MCCCXLI. 

Certain fub fiances taken from the animal 
kingdom feem to be much more powerful : 
And of thefe the chief, and feemingly the 
mofl powerful, is rnufk ; which, employed in 
its genuine flate, and in due quantity, has 
often been an effectual remedy. 

It is probable alfo, that the oleum animate, 
as it has been named, when in its pureft flate, 
and exhibited at a proper time, may be an ef- 
fectual remedy. 

MCCCXLII. 

In many difeafes, the mofl powerful anti- 
fpafmodic is certainly opium ; but the pro- 
priety of its ufe in epilepfy has been difputed 
D 2 among 



Si PRACTICE 

among phyficians. When the difeafe de- 
pends upon a plethoric ftate in which bleed- 
ing may be neceffary, the employment of 
opium is likely to be very hurtful ; but, when 
there is no plethoric or inflammatory ftate 
prefent, and the difeafe feems to depend upon 
irritation or upon increased irritability, opium 
is likely to prove the moft certain remedy. 
Whatever effects in this and other convulfive 
diforders have been attributed to the hyofcy- 
amus, m'uft probably be attributed to its pof- 
iefling a narcotic power fimilar to that of 
opium. 

MCCCXLIII. 

With refpect to the ufe of antifpafmodics, 
it is to be obferved, that they are always molt 
ufeful, and perhaps only ufeful, when em- 
ployed at a time when epileptic fits are fre- 
quently recurring, or near to the times of the 
acceffion of fits which recur after confiderable 
intervals. 

MCCCXLIV. 

On the fubjecl: of the cure of epilepfy, I 
have only to add, that as the difeafe in many 
cafes is continued by the power of habit only, 
and that in all cafes habit has a great (hare in 
increafing mobility, and therefore in contin- 
uing this difeafe ; fo the breaking in upon 
fuch habit, and changing the whole habits of 

the 



OF PHYSIC. 65 

the fyftem, is likely to be a powerful remedy 
in epilepfy. Accordingly, a conficlerable 
change of climate, diet, and other circum- 
ftances in the manner of life, has often proved 
a cure of this difeafe. 



MCCCXLV. 

After treating of epilepfy, I might here 
treat of particular convulfions, which are to 
be diftinguiihed from epilepfy by their being 
more partial : That is, affefting certain parts 
of the body only, and by their not being at- 
tended with a lofs of fenfe, nor ending in fuch 
a comatofe ftate as epilepfy always does. 

MCCCXLVF. 

Of fuch convulfive affections many differ- 
ent inflances have been obferved and record- 
ed by phyficians. But many of thefe have 
been manifeflly fympathic affections, to be 
cured only by curing the primary difeafe up- 
on which they depend, and therefore not to 
be treated of here : Or, though they are fuch 
as cannot be referred to another difeafe, as 
many of them however have not any fpecific 
character with which they occur in different 
perfons, I muft therefore leave them to be 
treated upon the general principles I have 
laid down with refpeci to epilepfy, or fhall lay 
down with refpecT: to the following convulfive 
D 3 diforder ; 



66 PRACTICE 

diforder ; which as having very conftantly in 
different perfons a peculiar character, I think 
neceffary to treat of more particularly. 



Chap. III. 



Of the Chorea or Dance of St. Vitu's. 

i 

MCCCXLVII, 

THIS difeafe affe&s both fexes, and al- 
moft only young perfons. It generally hap- 
pens from the age of ten to that of fourteen 
years. It comes on always before the age of 
puberty, and rarely continues beyond that 
period. 

MCCCXLVI1I. 

It is chiefly marked by con vul five motions, 
fomewhat varied in different perfons, but 
nearly of one kind in all ; affe&ing the leg 
and arm on the fame fide, and generally on 
one fide only. 

MCCCXLIX. 

Thefe convulfive motions commonly firil 
affect the leg and foot. Though the limb be 

at 



OF PHYSIC. 6 7 

at reft, the foot is often agitated bv convulfive 
motions, turning it alternately outwards and 
inwards. When walking is attempted, the 
affected leg is feluom lifted as ufual in walk- 
ing, but is dragged along as if the whole limb 
were paralytic ; and when it is attempted to 
be lifted, this motion is unfteadily performed, 
the limb becoming agitated by irregular con- 
vulfive motions. 

MCCCL. 

The arm of the fame fide is generally af- 
fected at the fame time ; and, even when no 
voluntary motion is attempted, the arm is fre- 
quently agitated with various convullive mo- 
tions. But efpecially when voluntary mo- 
tions are attempted, thefe are not properly 
executed, but are varioufly hurried or inter- 
rupted by convulfive motions in a direction 
contrary to that intended. The mod com- 
mon inftance of this is in the perfon's at- 
tempting to carry a cup of liquor to his 
mouth, when it is only after repeated efforts, 
interrupted by frequent convulfive retractions 
and deviations, that the cup can be carried to 
the mouth. 

MCCCLI. 

It appears to me, that the will often yields 

to thefe convulfive motions, as to a propen- 

fi ty, and thereby they are often increafed, 

D 4 while 



68 PRACTICE 

while the perfon afFecled feems plea fed with 
increafing the furprife and amufement which 
his motions occafion in the byflanders. 



MCCCLII. 

In this difeafe the mind is often affecled' 
with fome degree of fatuity ; and often fhows 
the fame varied, defultory, and caufelefs emo- 
tions which occur in hyfteria. 



MCCCLIII. 

Thefe are the mofl common circumflances 
of this difeafe ; but at times, and in different 
perfons, it is varied by fome difference in the 
convulfive motions, particularly by thefe af- 
fecting the head and trunk of the body. As 
in this difeafe there feem to be propenfities to 
motion, fo various fits of leaping and running 
occur in the perfons afFefted ; and there have 
been inflances of this difeafe, confiding of 
fuch convulfive motions, appearing as an epi- 
demic in a certain corner of the country. In 
fuch inflances, perfons of different ages are 
afFe&ed, and may feem to make an exception 
to the general rule above laid down ; but flill 
the perfons are, for the moft part, the young 
of both fexes, and of the more manifeftly 
moveaLl- conftitutions. 

MCCCLIV. 



OF PHYSIC. 69 



MCCCLIV. 

The method of curing this difeafe has been 
varioufly propofed. Dr. Sydenham propof- 
ed to cure it by alternate bleeding and purg- 
ing. In fome plethoric habits I have found 
fome bleeding ufeful ; but in many cafes I 
have found repeated evacuations, efpecially 
by bleeding, very hurtful. 

In many cafes, I have found the difeafe, 
in fpite of remedies of all kinds, continue for 
many months ; but I have alfo found it often 
readily yield to tonic remedies, fuch as the 
Peruvian bark, and chalybeates. 

The late Dr. De Haen found feveral per- 
fons labouring under this difeafe cured by the 
application of electricity. 



Vol. 3. D5 SECT. 



7 o PRACTICE 



SECT. II. 



of the SPASMODIC AFFECTIONS 01 
the VITAL FUNCTIONS. 



Chap. IV.* 
Of the Palpitation of the Heart. 

MCCCLV. 

1HE motion thus named is a 
contra&ion or fyftole of the heart, that is per- 
formed with more rapidity, and generally alfo 
with more force than ufual ; and when at the 
fame time the heart ftrikes with more than 
ulual violence againft the infide of the ribs, 
producing often a considerable found. 

MCCCLVI. 

This motion, or palpitation, is occafioned 
by a great variety of caufes, which have been 

recited 

* Though I have thought it proper to divide this book 
into feftions, I think it neceflary, for the convenience of 
references, to number the chapters from the beginning. 



OF PHYSIC. 71 

recited with great pains by Mr. Senac and 
others ; whom, however, I cannot follow in 
all the particulars with fufficient difcernment, 
and therefore mall here only attempt to refer 
all the feveral cafes of this difeafe to a few 
general heads. 

MCCCLVII. 

The firft is of thofe arifing from the appli- 
cation of the ufual ftimulus to the heart's con- 
traftion ; that is, the influx of the venous 
blood into its cavities,, being made with more 
velocity, and therefore, in the fame time, in 
greater quantity than ufual. It feems to be 
in this manner that violent exercife occafions 
palpitation. 

MCCCLVIII. 

A fecond head of the cafes of palpitation, 
is of thofe arifing from any refiftance given 
to the free and entire evacuation of the ven- 
tricles of the heart. Thus a ligature made 
upon the aorta occafions palpitations of the 
moft violent kind. Similar refiflances, either 
in the aorta or pulmonary artery, may be 
readily imagined ; and fuch have been often 
found in the dead bodies of perfons who, 
during life, had been much affefted with pal- 
pitations. 

To this head are to be referred all thofe 

cafes of palpitation arifing from cau its pro- 

D 6 ducing 



;2 PRACTICE 

during an accumulation of blood in the great 
veffels near to the heart. 

MCCCLIX. 

A third head of the cafes of palpitation, is 
of thofe arifing from a more violent and rapid 
influx of the nervous power into the mufcular 
fibres of the heart. It is in this manner that 
I fuppofe various caufes a&ing in the brain, 
and particularly certain emotions of the mind, 
occafion palpitation. 

MCCCLX. 

A fourth head of the cafes of palpitation, 
is of thofe arifing from caufes producing a 
weaknefs in the a&ion of the heart, by dimin- 
ifhing the energy of the brain with refpett to it. 
That fuch caufes operate in producing palpi- 
tation, I prefume from hence, that all the fev- 
eral caufes mentioned above (MCLXXVII 
etfeq.) as in this manner producing fyncope, 
do often produce palpitation. It is on this 
ground that thefe two difeafes are arTe&ions 
frequently occurring in the fame perfon, as 
the fame caufes may occafion the one or the 
other, according to the force of the caufe and 
mobility of the perfon a&ed upon. It feems 
to be a law of the human economy, that a 
degree of debility occurring in any function, 
©ften produces a more vigorous exertion of 

the 



OF PHYSIC. 73 

the fame, or at lead an effort towards it, and 
that commonly in a convulfive manner. 

I apprehend it to be the convulfive a&ion, 
frequently ending in fome degree of a fpafm, 
that gives occafion to the intermittent pulfe 
fo frequently accompanying palpitation. 

MCCCLXI. 

A fifth head of the cafes of palpitation may 
perhaps be of thofe arifing from a peculiar 
irritability or mobility of the heart. This, 
indeed, may be confidered as a predifponent 
caufe only, giving occafion to the action of 
the greater part of the caufes recited above. 
But it is proper to obferve, that this predifpo- 
fition is often the chief part of the remote 
caufe ; infomuch that many of the caufes pro- 
ducing palpitation would not have this effeft 
but in perfons peculiarly predifpofed. This 
head, therefore, of the cafes of palpitation, 
often requires to be diftinguifhed from all 
the reft. ' af 

MCCCLXII. 

After thus marking the feveral cafes and 
caufes of palpitation, I think it neceffary, with 
a view to the cure of this difeafe, to obferve, 
that the feveral caufes of it may be again re- 
duced to two heads. The firft is, of thofe 
confifting in, or depending upon, certain or- 
ganic affe&ions of the heart itfelf, or of the' 

great 



7 4 PRACTICE 

great veffels immediately connected with it. 
The fecond is, of thofe confiding in, or de- 
pending upon, certain affe&ions lubfifting 
and a&ing in other parts of the body, and act- 
ing either by the force of the caufe, or in con- 
fequence of the mobility of the heart. 

MCCCLXIII. 

With refpe£r, to the cafes depending upon 
the firft fet of caufes, I muft repeat here what 
I faid with refpecl: to the like cafes of fyncope, 
that I do not know any means of curing 
them. They, indeed, admit of fome pallia- 
tion, Jirfit by avoiding every circum fiance 
that may hurry the circulation of the blood ; 
andtfecondly, by every means of avoiding a 
plethoric Mate of the fyftem, or any occafion- 
al turgefcence of the blood. In many of 
thefe cafes, bloodletting may give a tempo- 
rary relief : But in fo far as debility and mo- 
bility are concerned, in fuch cafes this reme- 
dy is likely to do harm, 

MCCCLXIV. 

With refpecl: to the cafes depending upon 
the other fet of caufes, they may be various, 
and require very different meafures : But I 
can here fay in general, that thefe cafes may 
be confidered as of two kinds ; one depending 
upon primary affe&ions in other parts of the 
body, and a£ting by the force of the particu- 
lar 



OF PHYSIC. 75 

lar caufes ; and another depending upon a 
ftate of mobility in the heart itfelf. In the 
firfl of thefe, it is obvious, that the cure of 
the palpitation mult be obtained by curing 
the primary affection ; which is not to be 
treated of here. In the fecond, the cure rauft 
be obtained, partly by diligently avoiding the 
occafional caufes, partly and chiefly by cor- 
recting the mobility of the fyftem, and of the 
heart in particular ; for doing which we have 
treated of the proper means elfewhere. 



HAP. 



V. 



Of Dyspnoea, or Difficult Breath- 
ing. 



MCCCLXV. 

THE exercife of refpiraticfn, and the or- 
gans of it, have fo conftant and confiderable 
a connexion with almoft the whole of the 
other functions and parts of the human body, 
that upon almoft every occafion of difeafe, 
refpiration mull be affected. Accordingly 
fome difficulty and diforder in this function, 
are in fact fymptoms very generally accom- 
panying difeafe. 

MCCCLXVI. 



7 6 PRACTICE 

MCCCLXVI. 

Upon this account, the fymptom of diffi. 
cult breathing deferves a chief place and an 
ample confideration in the general fyftem of 
Pathology ; but what fhare of confideration it 
ought to have in a treatife of Practice, I find 
it difficult to determine. 

MCCCLXVII. 

On this fubjeft, it is, in the firft place nec~ 
effary to diftinguifh between the. fymptomatic 
and idiopathic affections ; that is, between 
thofe difficulties of breathing which are fymp- 
toms only of a more general affection, or of a 
difeafe fub filling primarily in other parts than 
the organs of refpiration, and that difficulty 
of breathing which depends upon a primary 
affe£tion of the lungs themfelves. The va- 
rious cafes of fymptomatic dyfpncea I have 
taken pains to enumerate in my Methodical 
Nofology, and it will be obvious they are 
fuch as cannot be taken notice of here. 

MCCCLXVIII. 

In my Nofology I have alfo taken pains to 
point out and enumerate the proper, or at 
leaft the greater part of the proper, idiopathic 
cafes of dyfpncea ; but from that enumeration 
it will, I think, readily appear, that few, and 

indeed 



OF PHYSIC. 77 

Mideed hardly any, of thefe cafes will admit 
or require much of our notice in this place. 

MCCCLXIX. 

The Dyfpncea Sicca, /pedes, 2d; the Dyf- 
pncea Aerea,fp. 3d, the Dyfpncea Terrea y fp.. 
4th, and Dyfpncea Thoracica, Jp. 7th, are 
fome of them with difficulty known, and are 
all of them difeafes which in my opinion do 
not admit of cure. All, therefore, that can 
be faid concerning them here is, that they may 
admit of fome palliation ; and this, I think, 
is to be obtained chiefly by avoiding a ple- 
thoric ftate of the lungs, and every circum- 
ftance that may hurry refpiration. 

MCCCLXX. 

Of the Dyfpncea Extrinftca,fp. Sth, I can 
fay no more, but that thefe external caufes 
marked in the Nofology, and perhaps fome 
others that might have like effects, are to be 
carefully avoided ; or, when they have been 
applied, and their eflfecls have taken place, 
the difeafe is to be palliated by the means 
mentioned in the lafl paragraph. 

MCCCLXXI. 

The other fpecies, though enumerated as 
idiopathic, can hardly be confidered as fuch, 
or as requiring to be treated of here. 

The 



78 PRACTICE 

The Dyfpncea Catarrhal^, fp. if, may be 
confidered as a fpecies of catarrh, and is pret- 
ty certainly to be cured by the fame remedies 
as that fpecies of catarrh which depends rath- 
er upon the increafed afflux of mucus to the 
bronchiae, than upon any inflammatory flate 
in them. 

The Dyfpncca Aquofa,fp. §th % is certainly 
to be confidered as a fpecies of dropfy, and is 
to be treated by the fame remedies as the 
other fpecies of that difeafe. 

The Dyfpncea Pinguedinofa, fp. 6th, is in 
like manner to be confidered as a fymptom 
or local efFect of the Polyfarcia, and is only 
to be cured by correcting the general fault of 
the fyftem. 

MCCCLXXII. 

From this view of thofe idiopathic cafes of 
dyfpncea, which are perhaps all I could prop- 
erly arrange under this title, it will readily 
appear that there is little room for treating of 
them here : But there is ftill one cafe of dif- 
ficult breathing, which has been properly 
diftinguifhed from every other under the title 
of Afhma ; and as it deferves our particular 
attention, I fhall here feparately confider it. 



Chap. 



OF PHYSIC. 79 



p. 



VI. 



Of Asthma. 

MCCCLXXIII. 

THE term of Afthma has been commonly 
applied by the vulgar, and even by many 
writers on the Practice of Phyfic, to every 
cafe of difficult breathing, that is, to every 
fpecies of Dyfpncea. The Methodical No- 
fologifts, alfo, have diftinguifhed Afthma from 
Dyfpncea chiefly, and almoft folely, by the 
former being the fame affeclion with the lat- 
ter, but in a higher degree. Neither of thefe 
applications of the term feems to have been 
correct or proper. I am of opinion, that the 
term Afthma may be mod properly applied, 
and fhould be confined, to a cafe of difficult 
breathing that has peculiar fymptoms, and 
depends upon a peculiar proximate caufe, 
which I hope to aflign with fufficient certain- 
ty. It is this difeafe I am now to treat of, 
and it is nearly what Practical Writers have 
generally diftinguifhed from the other cafes 
of difficult breathing, by the title of Spas- 
modic Afthma, or of AJihma convul/ivum ; 
although, by not diftinguifhing it with fuf- 
ficient 



3a PRACTICE 

ficient accuracy from the other cafes of Dyf- 
pncea, they have introduced a great deal of 
confufion into their treatifes on this fubjeft. 

MCCCLXXIV. 

The difeafe I am to treat of, or the Afth. 
ma to be ftri&ly fo called, is often a heredi- 
tary difeafe. It feldom appears very early in 
life, and hardly till the time of puberty, or 
after it. It affects both fexes, but moll fre- 
quently the male. I have not obferved it 
to be more frequent in one kind of tempera- 
ment than in another ; and it does not feem 
to depend upon any general temperament of 
the whole body, but upon a particular confti- 
tution of the lungs alone. It frequently at- 
tacks perfons of a full habit ; but it hardly 
ever continues to be repeated for fome length 
of time without occafioning an emaciation of 
the whole body. 

MCCCLXXV. 

The attacks of this difeafe are generally jf 
the night time, or towards the approach of 
night ; but there are alfo fome inflances of 
their coming on in the courfe of the day. At 
whatever time they come on, it is for the moft 
part fuddenly, with a fenfe of tightnefs and 
ftriclure acrofs the breaft, and a fenfe of 
ftraitnefs in the lungs impeding infpiration. 
The perfon thus attacked, if in a horizontal 

fituation x 



OF PHYSIC. 8i 

Situation, is immediately obliged to get into 
fomcwhat of an ere6l pofture, and requires a 
free and cool air. The difficulty of breath- 
ing goes on for fome time increafing ; and 
both infpiration and exfpiration are perform- 
ed flowly, and with a wheezing noife. In 
violent fits, fpeaking is difficult and uneafy. 
There is often fome propenfity to coughing, 
but it can hardly be executed. 

MCCCLXXVI. 

Thefe fymptoms often continue for many 
hours together, and particularly from mid- 
night till the morning is far advanced. Then 
commonly a remiffion takes place by degrees ; 
the breathing becomes lefs laborious and more 
full, fo that the perfon can fpeak and cough 
with more eafe ; and, if the cough brings up 
fome mucus, the remiffion becomes imme- 
diately more confiderable, and the perfon 
falls into a much wifhed for fleep. 

MCCCLXXVIL . 

During thefe fits the pulfe often continues 
in its natural Mate ; but in fome perfons the 
fits are attended with a frequency of pulfe, 
and with fome heat and third, as marks of 
fome degree of fever. If urine be voided at 
the beginning of a fit, it is commonly in con- 
fiderable quantity, and with little colour or 
odour ; but, after the fit is over, the urine 

voided 



82 PRACTICE 

voided is in the ordinary quantity, of a high 
colour, and fometimes depofites a fediment k 
In fome perfons, during the fit the face is a 
little flufhed and turgid ; but more common, 
ly it is fomewhat pale and fhrunk. 



MCCCLXXVIII. 

After fome fleep in the morning* the pa- 
tient, for the reft of the day, continues to have 
more free and eafy breathing, but it is feldom 
entirely fuch. He flill feels fome tightnefs 
acrofs his breaft, cannot breathe eafily in a 
horizontal poflure* and can hardly bear any 
motion of his body, without having his 
breathing rendered more difficult and uneafy, 
In the afternoon he has an unufual flatulency 
of his ftomach, and an unufual drowfinefs ; 
and, very frequently, thefe fymptoms precede 
the firfl attacks of the difeafe. But, whether 
thefe fymptoms appear or not, the difficulty 
of breathing returns towards the evening ; 
and then fometimes gradually increafes, till it 
becomes as violent as in the night before : Of 
if, during the day, the difficulty of breathing 
has been moderate, and the perfon gets fome 
fleep in the firfl part of the night, he is, how- 
ever, waked about midnight, or at fome time 
between midnight and two o'clock in the 
morning ; and is then fuddenly feized with a 
fit of difficult breathing, which runs the fame 
courfe as the night before. 

MCCQLXXIX, 






OF PHYSIC. 83 



MCCCLXXIX. 

In this manner fits return for feveral nights 
iucceflively ; but generally, after fome nights 
paffed in this way, the fits fuffer more con- 
fiderable remiffions. This efpecially hap- 
pens when the remilnons are attended with a 
more copious expectoration in the mornings, 
and that this continues from time to time 
throughout the day. In thefe circumftances, 
afthmatics, for a long time after, have not 
only more eafy days, but enjoy alfo nights of 
entire fleep, without the recurrence of the 
difeafe. 

MCCCLXXX. 

When this difeafe, however, has once taken 
|)lace in the manner above defcribed, it is 
ready to return at times for the whole of life 
after. Thefe returns, however, happen with 
different circumftances in different perfons. 

MCCCLXXXI. 

In fome perfons the fits are readily ex- 
cited by external heat, whether of the 
weather or of a warm chamber, and par- 
ticularly by warm bathing. In fuch perfons 
fits are more frequent in fummer, and partic- 
ularly during the dog days, than at other 
bolder feafons. The fame perfons are alfo 

readily 



$4 PRACTICE 

readily affected by changes of the weather $ 
efpecially by fudden changes made from a 
colder to a warmer, or, what is commonly the 
lame thing, from a heavier to a lighter atmof- 
phere. The fame perfons are alfo affected 
by evety circumftance ftraitening the capaci- 
ty of the thorax, as by any ligature made, or 
even by a plafter laid, upon it ; and a like ef- 
fect happens from any increafed bulk of the 
ftomach, either by a full meal, or by air col- 
lected in it. They are likewife much affect- 
ed by exercife, or whatever elfe can hurry the 
circulation of the blood. 

MCCCLXXXIL 

As afthmatic fits feem thus to depend upon 
fome fulnefs of the veffels of the lungs, it is 
probable that an obftruction of perfpiration, 
and the blood being lefs determined to the 
furface of the body, may favour an accumu- 
lation in the lungs, and thereby be a means 
of exciting afthma. This feems to be the 
cafe of thofe afthmatics who have fits moll 
frequently in the winter feafon, and who have 
commonly more of a catarrhal affection ac- 
companying the afthma ; which therefore oc- 
curs more frequently in winter, and more 
manifeftly from the application of cold. 

MCCCLXXXIII. 

Befide thefe cafes of afthma excited by heat 
or cold, there are others, in which the fits are 

efpecially 



OF P H V S I C, '85 

cfpedally excited by powers applied to the 
nervous fyflem ; as by paflions of the mind, 
by particular odours, and by irritations of 
fmoke and duft. 

That this difeafe is an affe&ion of the ner- 
vous fyftem, and depending upon a mobility 
of the moving fibres of the lungs, appears 
pretty clearly from its being frequently con- 
nected with other fpafmodic affections de- 
pending upon mobility ; fuch as hyfteria, hy- 
pochondriafis, dyfpepfia, and atonic gout, 

MCCCLXXXIV. 

From the whole of the hiftory of afthma 
now delivered, I think it will readily appear, 
that the proximate caufe of this difeafe is a 
preternatural, and in fome meafure a fpaf- 
modic, conftri&ion of the mufcular fibres of 
the bronchiae ; which not only prevents the 
dilatation of the bronchiae neceffary to a free 
and full infpiration, but gives alfo a rigidity 
which prevents a full and free exfpiration. 
This preternatural conftri&ion, like many 
other convulfive and fpafmodic affections, is 
readily excited by a turgefcence of the blood, 
or other caufe of any unufual fulnefs and dif- 
tention of the veffels of the lungs* 

MCCCLXXXV. 

This difeafe, as coming by fits, may be gen- 
erally diftinguiflied from mofl other fpecies 
Vol. III. E of 



86- PRACTICE 

of dyfpncea, whofe caufcs being more con- 
flantly applied, produce theiefore a more 
conflant difficulty of breathing. There may, 
however, be fome fallacy in this matter, as 
iome of thefe caufes may be liable to have 
abatements and intenftties, whereby the dyf- 
pnoea produced by them may feem to come 
by fits ; but I believe it is feldom that fuch 
fits put on the appearance of the genuine 
afthmatic fits defcribed above. Perhaps, 
however, there is flill another cafe that may 
give more difficulty ; and that is, when fev- 
,eral of the caufes, which we have affigned as 
caufes of feveral of the fpecies of difficult 
breathing referred to the genus of Dyfpncea, 
may have the effe£t of exciting a genuine 
afthmatic fit. Whether this can happen to 
any but the peculiarly predifpofed to aflhma, 
I am uncertain ; and therefore, whether, in 
any fuch cafes, the aflhma may be confidered 
as fymptomatic ; or if, in all fuch cafes, the 
aflhma may not flill be confiderecLand treated 
as an idiopathic difeafe. 

MCCCLXXXVI. 

The aflhma, though often threatening im- 
mediate death, feldom occafions it ; and many 
perfons have lived long under this difeafe. 
In many cafes, however, it does prove fatal ; 
fometimes very quickly, and perhaps always 
at length. In fome young perfons it has 
ended foon, by occafioning a phthifis pulmo- 

nalis. 



OF PHYSIC. 87 

fialis. After a long continuance, it often ends 
in a hydrothorax ; and commonly, by occa- 
fioning fome aneurifm of the heart or great 
veffels, it thereby proves fatal. 

MCCCLXXXVIl. 

As it is feldom that an afthma has been en- 
tirely cured ; I therefore cannot propofe any 
method of cure which experience has approv- 
ed as generally fuccefsfuJ. But the difeafe 
admits of alleviation in feveral refpecls from 
the ufe of remedies ; and my bufmefs now 
fhall be chiefly to offer fome remarks upon 
the choice and ufe of the remedies which 
have been commonly employed in cafes of 
afthma. 

MCCCLXXXVIII. 

As the danger of an afthmatic fit arifes 
chiefly from the difficult tranfmiflion of the 
blood through the veffels of the lungs, threat- 
ening fuffocation ; fo the mofl probable means 
of obviating this feems to be bloodletting ; and 
therefore, in all violent fits, practitioners have 
had recourfe to this remedy. In firfh at- 
tacks, and efpecially in young and plethoric 
perfons, bloodletting may be very neceflary, 
and is commonly allowable. But it is alfo 
evident, that, under the frequent recurrence 
of fits, bloodletting cannot be frequently re- 
peated without exhaufting and weakening the 
E 2 patient 



88 PRACTICE 

patient too much. It is further to be orj- 
ferved, that bloodletting is not fo neceilary as 
might be imagined, as the paifage of the blood 
through the lungs is not fo much interrupted 
as has been commonly fuppofed. This I 
particularly conclude from hence, that, in- 
flead of the fufFufion of face, which is the 
ufual efFecl: of fuch interruption, the face, in 
afthmatic fits, is often flirunk and pale. I 
conclude the feme alfo from this, that, in 
afthmatic fits, bloodletting does not com- 
monly give fo much relief as, upon the con- 
trary fuppofition, might be expected. 

MCCCLXXXIX. 

As I have alleged above, that a turgefcencs 
of the blood is frequently the exciting caufe 
of afthmatic fits, fo it might be fuppofed, that 
a plethoric flate of the fyflem might have a 
great fhare in producing a turgefcence of the 
blood in the lungs ; and efpecially, therefore, 
that bloodletting might be a proper remedy 
in afthma. I allow it to be fo in the firft at- 
tacks of the difeafe : But as the difeafe, by 
continuing, generally takes off the plethoric 
Hate of the fyftem ; fo, after the difeafe has 
continued for fome time, I allege that blood- 
letting becomes lefs and lefs neceffary. 

MCCCXC. 

Upon the fuppofition of afthmatics being 
in a plethoric flate, purging might be fuppof- 
ed 



OF PHYSIC. 89 

ed to prove a remedy in this difeafe : But, 
both becaufe the fuppofition is not common- 
lv well founded, and becaufe purging is fel- 
dom found to relieve the vell'els of the thorax, 
this remedy has not appeared to be well fuit- 
ed to afthmatics ; and large purging has al- 
ways been found to do much harm. But as 
aflhmatics are always hurt by the ft'agnation 
and accumulation of matters in the aliment- 
ary canal, fo coftivenefs muft be avoided, and 
an open belly proves ufeful. In the time of 
fits, the employment of emollient and mode- 
rately laxative giyfters has been found to give 
confiderable relief. 

MCCCXCI. 

As a flatulency of the ftomach, and other 
fymptoms of indigeftion, are frequent attend- 
ants of aflhma, and very troublefome to afth- 
matics ; fo, both for removing thefe fymp- 
toms, and for taking off all determination to 
the lungs, the frequent ufe of gentle vomits is 
proper in this difeafe. In certain cafes, 
where a fit was expected to come on in the 
courfe of the night, a vomit given in the 
evening has frequently leemed to prevent it. 

mcccxcii: 

Bliftering between the fhoulders, or upon 

the bread, has been frequently employed to 

relieve afthmatics ; but in the pure fpafmodic 

E 3 afthma 



9 o PRACTICE 

afthma we treat of here, I have rarely found 
blifters ufeful, either in preventing or reliev- 
ing fits. 

MCCCXCIII. 

I flues are certainly ufeful in obviating pleth- 
ora ; but as fuch indications feldom arife in 
cafes of afthma, fo indues have been feldom 
found ufeful in this difeafe. 

MCCCXCIV. 

As afthmatic fits are fo frequently excited 
by a turgefcence of the blood, fo the obviating 
and allaying of this by acids and neutral falts, 
feems to have been at all times the object of 
practitioners. See Floyer on the AJlhma. 

MCCCXCV. 

Although a plethoric ftate of the fyftem 
may feem to difpofe to afthma, and the occa- 
fional turgefcence of the blood may feem to 
be frequently the exciting caufe of the fits ; 
yet it is evident, that the difeafe mull have 
arifen chiefly from a peculiar conftitution in 
the moving fibres of the bronchiae, difpofing 
them upon various occafions to fall into a 
fpafmodic conftri&ion ; and therefore, that 
the entire cure of the difeafe can only be ex- 
pected from the correcting of that predifpofi- 
tion, or from correcting the preternatural 

mobility 



OF PHYSIC. 9* 

mobility or irritability of the lungs in that 
refpecl;. 

MCCCXCVI. 

In cafes wherein this predifpofition de- 
pends upon original conformation, the cure 
iimft be difficult, and perhaps impoflible ; but 
it may perhaps be moderated by the ule of 
antifpafmodics. Upon this footing, various 
remedies of that kind have been commonly 
employed, and particularly the fetid gums ; 
but we have not found them of any con fid- 
era ble efficacy, and have obferved them to he 
fometimes hurtful by their heating too much. 
Some other antifpafmodics which might be 
fuppofed powerful, fuch as mufk, have not 
been properly tried. The vitriolic ether has 
been found to give relief, but its effefts are 
not lafting. 

MCCCXCVII. 

As in other fpafmodic affeclions, fo in this, 
the mod certain and powerful antifpafmodic 
is opium. I have often found it effectual, 
and generally fafe ; and if there have arifen 
doubts with refpecl; to its fafety, I believe they 
have arifen from not diftincmifhincr between 
certain plethoric and inflammatory cafes of 
dyfpnoen, improperly named Afthma, and 
the genuine ipalmodic afthma we treat of 
here. 

E 4 MCCCXCVIII. 



g« PRACTICE 

MCCCXCVIII. 

As in many cafes this difeafe depends upon: 
a predifpofition which cannot be corrected by 
our art, fo in fuch cafes the patient can- only 
efcape the difeafe by avoiding the occafional 
or exciting caufes, which I have endeavoured 
to point out above. It is, however, difficult 
to give any general rules here, as different 
afthmatics have their different idiofyncrafies 
with refpect. to externals. Thus, one afth- 
matic finds himfelf eafiell living in the midft 
of a great city, while another cannot breathe 
but in the free air of the country. In the 
latter cafe, however, moft afthmatics bear the 
air of a low ground, if tolerably free and dry, 
better than that of the mountain. 

MCCCXCIX. 

In diet alfo, there is lbme difference to be 
made with refpeel: to different afthmatics. 
None of them bear a large or full meal, or 
any food that is of flow and difficult folution 
in the ftomach ; but many of them bear an- 
imal food of the lighter kinds, and in mode- 
rate quantity. The ufe of .vegetables which 
readily prove flatulent, are always very hurt- 
ful. In recent afthma, and efpecially in the 
young and plethoric, a fpare, light, and cool 
diet is proper, and commonly necefiary ; bur, 
after the difeafe has continued for years, afth- 
matics 



O F P H Y S I C. 93 

matics commonly bear, and even require, a 
tolerably full diet, though in all cafes a very 
full diet is very hurtful. 



MCCCC. 

In drinking, water, or cool watery liquors, 
is the only fafe and fit drink for afthjnatics ; 
and all liquors ready to ferment, and become 
flatulent, are hurtful to them. Few afthmat- 
ics can bear any kind of ftrong drink ; and 
any excefs in fuch is always very hurtful to 
them. As aflhmatics are commonly hurt by 
taking warm or tepid drink ; fo, both upon 
that account and upon account of the liquors 
weakening the nerves of the ftomach, neither 
tea nor coffee is proper in this difeafe.. 

mcccci. 



Aflhmatics commonly bear no bodily mo- 
tion eafily but that of the moft gentle kind. 
Riding, however, on horfeback, or going in a 
carriage, and efpecially failing, are very often 
ufeful to aflhmatics. 



Vol. 3. E 5 Chap. 



94 PRACTICE 

Chap. VII. 
Of ihe Ciiincough, or Hoopingcough. 

MCCCCII. 

THIS difeafe is commonly epidemic, and 
manifeftly contagious. It feems to proceed 
from a contagion of a fpecific nature, and of 
a lingular quality. It does not, "like moft 
other contagions, neceflarily produce a fever ; 
nor does it, like moft others, occafion any 
eruption, or produce otherwiie any evident 
change in the ftate of the human fluids. It 
has, in common with the catarrhal contagion, 
and with that of the meafles, a peculiar de- 
termination to the lungs ; but with particular 
effects there, very different from thofe of the 
other two ; as will appear from the hiftory of 
this difeafe now to be delivered. 

MCCCCIII. 

This contagion, like feveral others, affc&s 
perfons but once in the courfe of their lives ; 
and therefore, neceflarily, children are moft 
commonly the fubjecls of this difeafe : But 
there are many inftances of it occurring in 

perfons 



OF P II Y S I C. 95 

perfons considerably advanced in life ; though, 
it is probable, that the further that pei 
are advanced in life, they are the lels li 
to be affe&ed with this contagion. 

MCCCCIV. 

The difeafe commonly comes on with the 
ordinary fymptoms of a catarrh arifing from 
cold ; and often, for many days, keeps entire- 
ly to that appearance ; and I have had in- 
tlances of a difeafe which, though evidently 
arifing from the chincough contagion, never 
put on any other form than that of a com- 
mon catarrh. 

This, however, feldom happens ; for, gen- 
erally, in the fecond, and at farthest in the 
third week after the attack, the difeafe puts 
on its peculiar and chara&eriflic iymptom, a 
convulhve cough. This is a cough in which 
the exfpiratory motions peculiar to coughing 
are made with more frequency, rapidity, and 
violence, than ufual. As thefe circumftances, 
however, in different inflances of coughing, 
arc in very different degrees ; fo no exact 
limits can be put to determine when the cough 
can he ftri&ly laid to be convulhve ; and it 
is therefore especially by another circumftance 
that the chincough is diflinguifhed from every 
other form of cou<gh. This circumftance is, 
when many exfpiratory motions have been 
convullively made, and thereby the air is in 
•' quantity thrown out of the Lungs, a f aU 
E 6 infpiration 



96 PRACTICE 

infpiration is neceffarily and fuddenly made ; 
which, by the air ruffling in through the glot- 
tis with unufual velocity, gives a peculiar 
found. This found is fomewhat different in 
different cafes, but is in general called a 
Hoop ; and from it the whole of the difeafe 
is called the Hcopingcough. When this fo- 
norous infpiration has happened, the convul- 
five coughing is again renewed, and continues 
in the fame manner as belore, till a quantity 
of mucus is thrown up from the lungs, or the 
contents of the flomach are thrown up by 
vomiting. Either of thefe evacuations com- 
monly puts an end to the coughing, and the 
patient remains free from it for fome time 
after. Sometimes it is only after feveral al- 
ternate fits of coughing and hooping that ex- 
pectoration or vomiting takes place ; but it 
is commonly after the fecond coughing that 
thefe happen, and put an end to the fit. 

MCCCCV. 

When the difeafe, in this manner, has tak- 
en its prcper form, it generally continues for 
a long time after, and generally from one 
month to three; but lemetimes much longer, 
and that with very various circumflances. 

MCCCCVI. 

The fits of coughing return at various in- 
tervals, rarely obferving any exact, period. 

They 



OF PHYSIC. 97 

They hapffcn frequently in the courfe of the 
day, and more frequently flill in the courfe of 
the night. The patient has commonly fome 
warning of their coming on ; and, to avoid 
that violent and painful concufhon which the 
coughing gives to the whole body, he clings 
faft to any thing that is near to him, or demands 
to be held faft by any perfon that he can 
come at. 

When the fit is over, the patient fometimes 
breathes faft, and feems fafgued for a little 
after : But in many this appears very little ; 
and children are commonly fo entirely re- 
lieved, that they immediately return to their 
play, or what ell'c they were occupied in. 
before. 

MCCCCVII. 

If it happens that the fit of coughing ends 
in vomiting up the contents of the ftomacb, 
the patient is commonly immediately after 
feized with a ftrong craving and demand for 
food, and takes it in very greedily. 

MCCCCVIII. 

At the firft coming on of this difeafe, the 
expectoration is fometimes none at all, or of 
a thin mucus only ; and while this continues 
to be the cafe, the fits of coughing are more 
violent, and continue longer : But commonly 
the expectoration foon becomes confiderable, 

and 



98 PRACTICE 

and a very thick mucus, often irif^reat quan- 
tity, is thrown up ; and as this is more readily 
brought up, the fits of coughing are of fhorter 
duration. 

MCCCCIX. 

The violent fits of coughing frequently in- 
terrupt the free tranfmiffion of the blood 
through the lungs, and thereby the free re- 
turn of blood from the vefTels of the head. 
This occafions that turgefcence and fufFufion 
of face which commonly attends the fits of 
coughing, and feems to occafion alfo thofe 
eruptions of blood from the nofe, and even 
from the eyes and ears, which fometimes 
happen in this difeafe. 

MCCCCX. 

This difeafe often takes place in the man- 
ner we have now defcribed, without any py- 
rexia attending it; but, though Sydenham 
had feldom obferved it, we have found the 
difeafe very frequently accompanied with py- 
rexia, fomefimes from the very beginning, but 
more frequently only after the ctifeafe had 
contim ed for fome time. When it does ac- 
company the difeafe, we have not found it 
appearing under any regular intermittent 
form. It is conflantly in feme pref- 

ent ; but with evident exacerbations tc 
evening, continuing till next mom 'irr. 

MCCCCXI. 



OF PHYSIC. 99 



MCCCCXI. 

Another fymptom very frequently attend- 
ing the chincough, is a difficulty of breath- 
ing • and that not only immediately before 
and after fits of coughing, but as conftantly 
prefent, though in different degrees in differ- 
ent perfons. I have hardly ever feen an in- 
f lance of a fatal chincough, in which a con- 
fiderable degree of pyrexia and dyfpncea had 
not been for fome time conftantly prefent. 

MCCCCXII. 

When by the power of the contagion this 
difeafe has once taken place, the fits of cough- 
ing are often repeated, without any evident 
exciting caufe : But, in many cafes, the con- 
tagion may be confidered as giving a predif- 
pofition only ; and the frequency of fits de- 
pends in fome meafure upon various exciting 
caufes ; fuch as, violent exercife ; a full meal ; 
the having taken in food of difficult folution ; 
irritations of the lungs by duff, fmoke, or dif- 
agreeable odours of a ftrong kind ; and efpec- 
ially any confiderable emotion of the mind. 

MCCCCXIII. 

Such are the chief circumftanccs of this 
difeafe, and it is of various event ; which, 

however, 



too P R A C T I C E 

however, may be commonly forefeen by at-- 
tending to the following con fide rations. 

The younger that children are, they are in 
the greater danger from this dileafe ; and of 
thofe to whom it proves fatal, there are many 
more under two years old than above it. 

The older that children are, they are the 
more fecure againfl an unhappy event ; and 
this I hold to be a very general rule, though 
I own there are many exceptions to it. 

Children born of phthisical and affhmatic 
parents are in the greateft danger from thii 
dileafe. 

When the dileafe, beginning in the form of 

a catarrh, is attended with fever and difficult 

breathing, and with little expectoration, it 

often proves fatal, without taking on the form 

of the hoopingcough ; but, in mofl of fuch 

cafes, the coming on of the convulfive cou<jh 

and hooping, bringing on at the fame time a 

more free expectoration, generally removes 

the danger, 
o 

When the difeafe is fully formed, if the fits 
are neither frequent nor violent, with mod- 
erate expectoration, and the patient, during 
the intervals of the fits, is eafy, keeps his ap- 
petite, gets fleep, and is without fever or dif- 
ficult breathing, the difeafe is attended with 
no danger; and thefe circumftances becoming 
daily more favourable, the difeafe very foon 
fpontaneoufly terminates. 

An expectoration, either very fcanty or 
very copious, is attended with danger ; Spec- 
ially 



OF PHYSIC. 101 

ially if the latter circumftance is attended 
with great difficulty of breathing. 

Thofe cafes in which the fits terminate by 
a vomiting, and are immediately followed 
by a craving of food, are generally without 
danger. 

A moderate hemorrhagy from the nofe 
often proves falutary ; but very large hernor— 
rhagies are generally very hurtful. 

This difeafe coming upon perfons under a. 
Mate of much debility, has very generally an 
unhappy event. 

The danger of this difeafe fometimes arifes 
from the violence of the fits of coughing, oc- 
cafioning apoplexy, epilepfy, or immediate 
fuffbcation : But thefe accidents are very 
rare ; and the danger of the difeafe feems 
generally to be in proportion to the fever and 
dyfpncea attending it. 

MCCCCXIV. 

The cure of this difeafe has been always 
confidered as difficult, whether the purpofe 
be to obviate its fatal tendency when it is vi- 
olent, or merely to fhorten the courfe of it 
when it in mild. When the contagion is re- 
cent, and continues to a 61, we neither know 
how to correct, nor how to expel it ; and 
therefore the difeafe necelfarily continues for 
fome time : But it is probable, that the con- 
tagion in this as in other inftances ceafes at 
length to acl; ; and that then the difeafe con- 
tinues,, 



102 PRACTICE 

tinues, as in other convullive affections, by 
the power of habit alone. 

MCCCCXV. 

From this view of the matter I maintain, . 
that the practice rauft be different, arid adapt- 
ed to two different indications, according to 
the period of the difeafe. At the beginning 
of the difeafe, and for fome time after, the 
remedies to be employed muff be fuch as may- 
obviate the violent effe&s of the difeafe, and 
the fatal tendency of it ; but, after the difeafe 
has continued for fome time, and is without 
any violent fymptoms, the only remedies 
which can be required are thofe which may 
interrupt its courfe, and put an entire flop 
to it fooner than it would have fpontaneoufly 
ceafed. 

MCCCCXVI. 

For anfwering the firft indication. In ple- 
thoric fubjecls, or in others, when from the 
circumftances of the cough and fits it appears 
that the blood is difficultly tranfmitted through 
the lungs, bloodletting is a neceflary remedy ; 
and it may be even necefTary to repeat it, ef- 
pecially in the beginning of the difeafe : But, 
as fpafmodic affections do not commonly ad- 
mit of much bleeding, fo it is feldom proper 
in the chincough to repeat this remedy often. 

MCCCCXVII. 



OF PHYSIC. 103 



• MCCCCXVII. 

As coftivenefs frequently attends this dif- 
eafe, fo it is neceflary to obviate or remove 
it by laxatives employed ; and keeping an 
open belly is generally ufeful : But large 
evacuations in this way are commonly hurt- 
ful. 

MCCCCXVIII. 

To obviate or remove the inflammatory de- 
termination to the lungs that fometimes oc- 
curs in this difeafe, bliftering is often ufeful, 
and even repeated bliftering has been of fer- 
vice ; but iffues have not fo much effect, and 
mould by no means fuperfede the repeated 
bliftering that may be indicated. When 
blifters are proper, they are more effectual 
when applied to the thorax, than when ap- 
plied to any diftant parts. 

MCCCCXIX. 

Of all other remedies, emetics are the molt 
ufeful in this difeafe ; both in general by in- 
terrupting the return of fpafmodic affections, 
and in particular by determining very power- 
fully to the furface of the body, and thereby 
taking off determinations to the lungs. For 
thefe purpofes, I think, full vomiting is fre- 
quently to be employed ; and, in the inter- 
vals 



104 PRACTICE 

vals necefTary to be left between the times of 
full vomiting, naufeating dofes of the anti- 
monial emetics may be ufeful. I have never 
found the fulphur auratmn, fo much praifed 
by Cloffius, to be a convenient medicine, on 
account of the uncertainty of its dofe ,- and 
the tartar emetic employed in the manner di- 
rected by the late Dr. Fothergill, has appear- 
ed to be more ufeful. 

MCCCCXX. 

Thefe are the remedies to be employed in 
the firft ftage of the difeafe for obviating its 
fatal tendency, and putting it into a fafe train. 
But in the fecond ftage, when I fuppofe the 
contagion has ceafed to aft, and that the dif- 
eafe continues merely by the power of habit, 
a different indication arifes, and different 
remedies are to be employed. 

MCCCCXXI. 

This difeafe, which often continues for a 
long time, docs not, in my opinion, continue 
during the whole of that time in confequence 
of the contagion's remaining in the body, and 
continuing to act. in it. That the difeafe docs 
often continue long after the contagion has 
ceafed to att, and that too by the power of 
habit alone, appears to me probable from 
hence, that terror has frequently cured the 
difeafe ; that any confiderable change in the 

flate 



OF PHYSIC. 105 

Rate of the fyflem, fuch as the coming on of 
the fmall pox, has alfo cured it ; and, laftly, 
that it has been cured by antifpafmodic and 
tonic medicines ; whilft none of all thefe 
means of cure can be fuppofed either to cor- 
rect or to expel a morbific matter, though they 
are evidently fuited to change the ftate and 
habits of the nervous fyflem. 



MCCCCXXII. 

From this view we are directed to the in- 
dication that may be formed, and in a great 
meafure to the remedies which may be em- 
ployed in what we fuppofe to be the fecond 
ftage of the difeafe. It may perhaps be al- 
leged, that this indication of fhortening the 
courfe of the difeafe is not very important 
or neceffary, as it fuppofes that the violence 
or danger is over, and, in confequence, that 
the difeafe will foon fpontaneoufly ceafe. 
The lafl fuppofition, however, is not well 
founded ; as the difeafe, like many other con- 
vulfive and fpafmodic affections, may con- 
tinue for a long time by the power of habit 
alone, and by the repetition of paroxyfms 
may have hurtful effects ; more efpecially as 
the violence of paroxyfms, and therefore their 
hurtful effe&s, may be much aggravated by 
various external caufes that may be accident- 
ally applied. Our indication, therefore, is 
proper ; and we proceed to conlider the fev- 

eral 



106 PRACTICE 

eral remedies which may be employed to 
anfwer it. 

MCCCCXXIII. 

Terror may poflibly be a powerful rem- 
edy, but is is difficult to meafure the degree 
of it that mail be produced ; and, as a flight 
degree of it may be ineffectual, and a high 
degree of it dangerous, I cannot propofe to 
employ it. 

MCCCCXXIV. 

The other remedies which we fuppofe hik- 
ed to our fecond indication, and which in- 
deed have been frequently employed in this 
difeafe, are antifpafmodics or tonics. 

Of the antifpafmodics, caftor has been par- 
ticularly recommended by Dr. Morris ; but 
in many trials we have not found it effectual. 

With more probability mufk has been em- 
ployed : But whether it be from our not hav- 
ing it of a genuine kind, or not employing it 
in fufficiently large dofes, I cannot determine j 
but we have not found it commonly iuccefs- 
ful. Of antifpafmodics, the moft certainly 
powerful is opium : And when there is no 
confiderable fever or difficulty of breathing 
prefent, opium has often proved ufeful in 
moderating the violence of the chincough ; 
but I have not known it employed fo as "en- 
tirely to cure the difeafe. 

If 



OF PHYSIC. 107 

If hemlock has proved a remedy in this 
difeafe, as we mud believe from Dr. Butter's 
accounts, I agree with that author, that it is 
to be confidered as an antifpafmodic. Upon 
this fuppolition, it is a probable remedy ; and 
from the accounts of Dr. Butter and fome 
others, it feems to have been often ufeful : 
but, in our trials, it has often difappointed us, 
perhaps from the preparation of it not having 
been always proper. 



MCCCCXXV. 

Of the tonics, I confider the cupmofs, for- 
merly celebrated, as of this kind ; as alfo the 
bark of the mifletoe : But I have had no ex- 
perience of either, as I have always trufted to 
the Peruvian bark. I confider the ufe of 
this medicine as the mod certain means of 
curing the difeafe in its fecond ftage ; and 
when there has been little fever prefent, and 
a fufficient quantity of the bark has been giv- 
en, it has feldom failed of foon putting an 
end to the difeafe. 



MCCCCXXVI. 

When convulfive diforders may be fup- 
pofed to continue by the force of habit alone, 
it has been found that a confiderable change 

in 



io8 PRACTICE 

in the whole of the circumftances and manner 
of life has proved a cure of fuch difeafes ; and 
analogy has applied this in the cafe of the 
chincough fo far, that a change of air has 
been employed, and fuppofed to be ufeful. 
In feveral inftances I have obferved it to be 
fo ; but I have never found the effects of it 
durable, or fufficient to put an entire (lop to 
the difeafe. 



SECT. 



OF PHYSIC. 109 



SECT. III. 



of the SPASMODIC AFFECTIONS in 
the NATURAL FUNCTIONS. 



Chap. VIII. 



Of the Pyrosis, or what is named in/Scotland 
the Water Brash. 



MCCCCXXVII. 

1 HE painful fenfations re- 
ferred to the ftomach, and which are proba- 
bly occafioned by real affections of this organ, 
are of different kinds. Probably they proceed 
from affections of different natures, and mould 
therefore be diflinguifhed by different appel- 
lations ; but I muft own that the utmofl precif- 
ion in this matter will be difficult. In my effay 
towards a methodical Nofology, I have, how- 
ever, attempted it. For thofe pains that are 
cither acute and pungent, or accompanied 
with a fenfe of diftention, or with a fenfe of 
conftric"lion, if they are at the fame time not 
attended with any fenfe of acrimony or heat, 
Vol. III. F I employ 



no PRACTICE 

I employ the appellation of Gaftrodynia. 
To exprefs thofe painful or uneafy fenfations 
which feem to arife from a fenfe of acrimony 
irritating the part, or from fuch a (enfc of 
heat as the application of acrids, whether ex- 
ternally or internally applied, often gives, I 
employ the term of Cardialgia ; and by this . 
I particularly mean to denote thofe feelings 
which arc expreffed by the term Heartburn 
in the Englifh language. I think the term 
Soda has been commonly employed by prac- 
tical writers to exprefs an affection attended 
v ith feelings of the latter kind. 

MCCCCXXVIII. 

Befide the pains denoted by the terms Gaf- 
t rodynia, Periadynia, Cardialgia, and Soda, 
rhere is, I think, another painful fenfation 
different from all of thefe, which is named by 
Mr. Sauvages Pyrofis Suecica ; and his ac- 
count of it is taken from Linnaeus, who names 
it Cardialgia Sputatoria. Under the title of 
Pyrofis Mr. Sauvages has formed a genus, of 
which the whole of the fpecies, except the 
eighth, which he gives under the title of Py- 
rofis Suecica, are all of them fpecies of the 
Gaftrodynia or of the Cardialgia ; and if there 
is a genus to be formed under the title of Py- 
rofis, it can in my opinion comprehend only 
the fpecies I have mentioned. In this cale, 
indeed, I own that the term is not very prop- 
er ; but my averfion to introduce new names 

ha* 



OF PHYSIC. in 

has made me continue to employ the term of 
Mr. Sauvages. 

MCCCCXXIX. 

The Gaftrodynia and Cardialgia I judge to 
be for the moft part fymptomatic affections ; 
and therefore have given them no place in 
this work : But the Pyrohs, as an idiopathic 
difeafe, and never before treated of in am 
fyftem, I propofe to treat of here. 

MCCCCXXX. 

It is a difeafe frequent among people in 
lower life ; but occurs alfo, though more 
rarely, in people of better condition. Though 
frequent in Scotland, it is by no means fo 
frequent as Linnaeus reports it to be in Lap- 
land. It appears moft commonly in perfons 
under middle age, but feldom in any perfons 
before the age Of puberty. When it has 
once taken place, it is ready to recur occa- 
(ionally for a long time after ; but it feldom 
appears in perfons considerably advanced in 
life. It affecls both fexes, but more frequent- 
ly the female. It fometimes attacks pregnant 
women, and tome women only when they are 
in that condition. Of other women, it more 
frequently affe&s the unmarried ; and of the 
married, moft frequently the barren. I have 
had many inftances of its occurring in women 
labouring under a fluor albus. 

F2 MCCCCXXXI. 



112 PRACTICE 



MCCCCXXXI. 

The fits of this difeafe ufually come on in 
the morning and forenoon, when the flomach 
is empty. The firft fymptom of it is a pain 
at the pit of the flomach, with a fenfe of con- 
flri&ion, as if the flomach was drawn towards 
the back ; the pain is increafed by raifing the 
body into an creel poflure, and therefore the 
body is bended forward. This pain is often 
very fevere j and, after continuing for fome 
time, it brings on an cruftation of a thin wa- 
tery fluid in confiderable quantity. This 
fluid has fometimes an acid tafte, but is very 
often abfolutely infipid. The eructation is 
for fome time frequently repeated ; and does 
not immediately give relief to the pain which 
preceded it, but does fo at length, and puts an 
end to the fit. 

MCCCCXXXII. 

The fits of this difeafe commonly come on 
without any evident exciting caufe ; and I 
have not found it fleadily connected with any 
particular diet. It attacks peffons u ling an- 
imal food, but I think more frequently thofe 
living on milk and farinacea. It feems often 
to be excited by cold applied to the lower ex- 
tremities ; and is readily excited by any con-* 
fiderable emotion of mind. It is often with- 
out any fymptoms of dyfpepfia. 

MCCCCXXXIIL 



OF PHYSIC. 113 



MCCCCXXXIII. 

The nature of this affection is not very ob- 
vious ; but I think it may be explained in 
this manner : It feems to begin by a fpafm of 
the mufcular fibres of the ftomach ; which is 
afterwards, in a certain manner, communicat- 
ed to the bloodveflels and exhalants, fo as to 
increafe the impetus of the fluids in thefe vef- 
fels, while a conftrittion takes place on their 
extremities. While therefore the increafed 
impetus determines a greater quantity than 
ufual of fluids into thefe veflels, the confine- 
tion upon their extremities allows only the 
pure watery parts to be poured out, analo- 
gous, as I judge, in every refpec~t, to what 
happens in the diabetes hyftericus. 

MCCCCXXXIV. 

The practice in this difeafe is as difficult as 
the theory. The paroxyfm is only to be cer- 
tainly relieved by opium. Other antifpaf- 
modics, as vitriolic ether and volatile alkali, 
are fometimes of fervice, but not conftantly 
fo. Although opium and other antifpaf- 
modics relieve the fits, they have no effecT; in 
preventing their recurrence. For this pur- 
pofe, the whole of the remedies of dyfpepfia 
have been employed-without fuccefs. Of the 
ufe of the nux vomica, mentioned as a rem- 
edy by Linnaeus, I have had no experience. 
F 3 Chap. 



)i 4 PRAC T I C £ 

C H A P. IX. 

0/ the Colic. 

MCCCCXXXV. 

THE principal fymptom of this difeafe, is 
a pain felt in the lower belly. It is feldom 
iixed and pungent in one part, but is a pain- 
ful diftention in Come meafure fpreading over 
the whole of the belly ; and particularly with 
a fenfe of twilling or wringing round the 
navel. At the fame time, with this pain, the 
navel and teguments of the belly are frequent- 
ly drawn inwards, and often the mufcles of 
the belly are fpafmodically contracted, and 
this in feparate portions, giving the appear- 
ance of aba*r full of round balls. 

o 

MCCCCXXXVI. 

Such pains, in a certain degree, fometimes 
occur in cafes of diarrhoea and cholera ; but 
thefe are lefs violent and more tranfitory, and 
are named Gripings. It is only when more 
violent and permanent, and attended with 
coflivenefs, that they conflitute colic. This 
is alfo commonly attended with vomiting, 

which 



OF P H Y 5 1 C. 115 

which in many cafes is frequently repeated, 
efpecially when any thing is taken down into 
the ftomach ; and in fuch vomitings, not only 
the contents of the ftomach are thrown up, 
but alfo the contents of the duodenum, and 
therefore frequently a quantity of bile. 

MCCCCXXXvft. 

In fome cafes of colic, the periftaltic mo- 
tion is inverted through the whole length of 
the alimentary canal, in fuch a manner that' 
the contents of the great guts, and therefore 
flercoraceous matter, is thrown up by vom- 
iting ; and the fame inverfion appears ft ill 
more clearly from this, that what is thrown 
into the re&um by glyfter is again thrown out 
by the mouth. In thefe circumftances of in- 
verfion the difeafe has been named Ileus, or 
the Iliac Paffion ; and this has been fuppof- 
ed to be a peculiar difeafe diftincl; from colic ; 
but Co me it appears that the two difeafes are 
owing to the fame proximate caufe, and have 
the fame fymptoms, only in a different degree. 

MCCCCXXXVIII. 

The colic is often without any pyrexia at- 
tending it. Sometimes, however, an inflam- 
mation comes upon the part of the interline 
efpecially affetted ; and this inflammation 
aggravates all the fymptoms of the difeafe, 
being probably what briugs on the moft con- 
F 4 fiderable 



n6 P R A C T I C E 

fiderable inverfion of the periftaltic motion • 
and, as the ftercoraceous vomiting is what 
efpecially diftinguifhes the ileus, this has been 
confidered as always depending on an inflam- 
mation of the inteftines. However, I can af- 
firm, that as there are inflammations of the 
inteftines without ftercoraceous vomiting, fo 
I have feen irmances of ftercoraceous vomit- 
ing without inflammation ; and there is there- 
fore no ground for diftinguifhing ileus from 
colic, but as a higher degree of the lame af- 
fection. 

MCCCCXXXIX. 

The fymptoms of the colic, and the diffec- 
tions of bodies dead of this difeafe, fhow very 
clearly that it depends upon a fpafmodic con- 
flriclion of a part of the inteftines ; and that 
this therefore is to be confidered as the prox- 
imate caufe of the difeafe. In fome of the 
diffedlions of perfons dead of this difeafe, an 
intus fufception has been remarked to have 
happened ; but whether this be conftantly 
the cafe in all the appearances of ileus, is not 
certainly determined. 

MCCCCXL. 

The colic has commonly been confidered as 
being of different fpecies, but I cannot follow 
the writers on this fubjett in the diftin&ions 
they have eftablifhed. So far, however, as a 

difference 



OF P H Y S I C. 117' 

difference of the remote caufe conftitutes a 
difference of fpecies, a diftinaion may per- 
haps be admitted ; and accordingly in my 
Nofology I have marked feven different fpe- 
cies : But I am well perfuaded, that in all 
thefe different fpecies the proximate caufe is 
the fame, that is, a fpafmodic conftriaion of 
a part of the inteftines ; and confequently, 
that in all thefe cafes the indication of cure 
is the fame, that is, to remove the conftric- 
tion mentioned. Even in the feveral fpecies 
named Stercorea y Callofa, and Calculofa, in 
which the difeafe depends upon an obftruc- 
tion of inteftine, I am perfuaded that thefe 
obftruclions do not produce the fymptoms of 
colic, excepting in fo far as they produce fpaf- 
modic conftri&ions of the inteftines ; and 
therefore, that the means of cure in thefe 
cafes, fo far as they admit of cure, muft be 
obtained by the fame means which the gen- 
eral indication above mentioned fuggefts. 



MCCCCXLI.. 



The cure, then, of the colic univerfally, is 
to be obtained by removing the fpafmodic 
conftri&ions of the inteftines ; and the rem- 
edies fuited to this purpofe may be referred 
to three general heads : 

1 . The taking off the fpafm by various an- 
ti fpafmodic powers. 

Vol. 3. F5 2. The 



n8 PRACTICE 

2. The exciting the action of the inteftines 
by purgatives. 

3. The employing mechanical dilatation. 

MCCCCXLII. 

Before entering upon a more particular ac- 
count of thefe remedies, it will be proper to 
obferve, that in all cafes of violent colic, it is 
advifeable to pra&ife bloodletting ; both as it 
may be ufeful in obviating the inflammation 
which is commonly to be apprehended, and 
even as it may be a means of relaxing the 
1'pafin of the inteftine. This remedy may 
perhaps be improper in perfons of a weak 
and lax habit, but in all perfons of tolerable 
vigour it will be a fafe remedy ; and in all 
cafes where there is the lea ft fufpicion of an 
inflammation actually coming on, it will be 
abfolutely neceffary. Nay, it will be even 
proper to repeat it perhaps feveral times, if, 
with a full and hard pulie, the appearance of 
the blood drawn, and the relief obtained by 
the firfl bleeding, fhall authorife fuch repe- 
tition. 

MCCCCXLIII. 

The antifpafmodic powers that may be 
employed, are, the application of heat in a 
dry or humid form, the application of blif- 
ters, the ufe of opium, and the ufe of mild 



CJL' 



le 



The 



OF P 11 Y ST C. 119 

The application of heat, in a dry form, has 
oeen employed by applying to the belly of 
the patient a living animal, or bladders filled 
with warm water, or Wags of fubftances which 
long retain their heat; and all thefe have 
ibmetimes been applied with fuccefs ; but 
none of them feem to me fo powerful as the 
application -of heat in a humid form. 

This may be employed either by the im- 
merfion of a great part of the body in warm 
water, or by fomenting the belly with cloths 
wrung out of hot water. The immerfion has 
advantages from the application of it to a 
greater part of the body, and particularly to 
the lower extremities : But immerfion cannot 
always be conveniently pra&ifed, and fomen- 
tation may have the advantage of being long- 
er continued ; and it may have nearly all the 
benefit of immerfion, if it be at the fame time 
applied both to the belly and to the lower 
extremities. 

MCCCCXLIV. 

From confidering that the teguments of the 
lower belly have fuch a connexion with the 
inteftines, as at the fame time to be affec~led 
with Ipafmodic contractions, we perceive that 
blifters applied to the belly may have the ef- 
fect of taking off the fpafms both from the 
mufcles of the belly and from the inteftines ; 
and accordingly, blifteving has often been em- 
F 6 ployed 



120 PRACTICE 

ployed in the colic with advantage. Anal- 
ogous to this, rubefacients applied to the belly 
have been frequently found ufeful. 

MCCCCXLV. 

The ufe of opium in colic may feem to be 
an ambiguous remedy. Very certainly it 
may for fome time relieve the pain, which is 
often fo violent and urgent, that it is difficult 
to abftain from the ufe of fuch a remedy. At 
the fame time, the ufe of opium retards or 
iufpends the periflaltic motion fo much, as to 
allow the interlines to fall into conftriclions ; 
and may therefore, while it relieves the pain, 
render the caufe of the difeafe more obflinate. 
On this account, and further as opium pre- 
vents the operation of purgatives fo often nec- 
effary in this difeafe, many practitioners are 
averfe to the ufe of it, and fome entirely re- 
ject the ufe of it as hurtful. There are, 
however, others who think they can employ 
opium in this difeafe with much advantage. 

In all cafes where the colic comes on with- 
out any previous coftivenefs, and arifes from 
cold, from pafhons of the mind, or other 
caufes which operate efpecially on the ner- 
vous fyftem, opium proves a fafe and certain 
remedy ; but in cafes which have been pre- 
ceded by long coftivenefs, or where the colic, 
though not preceded by coftivenefs, has how- 
ever continued for fome days without a ftool, 
fo that a ftagnation of fasces in the colon is to 

be 



OF PHYSIC. 121 

be fufpe&ed, the ufe of opium is of doubtful 
effeft. In fuch cafes, unlefs a ftool has been 
firft procured by medicine, opium cannot be 
employed but with fome hazard of aggravat- 
ing the difeafe. However, even in thofe 
circumftances of coftivenefs, when, without 
inflammation, the violence of the fpafm is to 
be fufpe&ed, when vomiting prevents the ex- 
hibition of purgatives, and when with all this 
the pain is extremely urgent, opium is to be 
employed, not only as an anodyne, but alfo 
as an antifpafmodic, neceffary to favour the 
operation of purgatives ; and may be fo em- 
ployed, when, either at the fame time with 
the opiate, or not long after it, a purgative 
can be exhibited. 

Is the hyofciamus, as often mowing, along 
with its narcotic, a purgative quality, better 
fuited to this difeafe than opium ? 



MCCCCXLVI. 

It is feemingly on good grounds that fev- 
eral practitioners have recommended the large 
ufe of mild oils in this difeafe, both as anti- 
fpafmodics and as laxatives ; and, where the 
palate and ftomach could admit them, I have 
found them very ufeful. But as there are 
few Scottifh ftomachs that can admit a large 
ufe of oils, I have had few opportunities of 
employing them. 

MCCCCXLVIL 



122 PRACTI C E 



MCCCCXLVII. 

The fecond fet of remedies adapted to the 
cure of colic, are purgatives ; which, by ex- 
citing the action of the interlines, either above 
or below the obftru&ed place, may remove 
the conftriction ; and therefore thefe purga- 
tives may be given either by the mouth, or 
thrown by glyfter into the anus. As the dif- 
eafe is often feated in the great guts ; as glyf- 
ters, by having a more fudden operation, may 
give more immediate relief ; and as purga- 
tives given by the mouth are ready to- be re- 
jected by vomiting ; fo it is common, and in- 
deed proper, to attempt curing the colic in 
the firfl place by glyfters. Thefe may at firft 
be of the mildeft kind, confiding of a large 
bulk of water, with fome quantity of a mild 
oil ; and fuch are fometimes fufficiently effi- 
cacious : However, they are not always fo ; 
and it is commonly neceffary to render them 
more powerfully ftimulant by the addition of 
neutral falts, of which the mod powerful is 
the common or marine fait. If thefe faline 
glyfters, as fometimes happens, are rendered 
again too quickly, and on this account or oth- 
envife are found ineffectual, it may be proper, 
inftead of thefe falts, to add to the glyfters an 
infufion of fenna, or of fome other purgative 
that can be extracted by water. The anti- 
monial wine may be fometimes employed in 
glyfters with advantage. Hardly any glyfters 

are 



OF PHYSIC. 123 

are more effectual than thofe made of turpen- 
tine properly prepared. When all other in- 
jections are found ineffectual, recourfe is to 
be had to the injection of tobacco fmoke ; 
and, when even this fails, recourfe is to be 
had to the mechanical dilatation to be men- 
tioned hereafter. 

MCCCCXLVIII. 

As glyfters often fail altogether in relieving 
this difeafe, and as even when they give fome 
relief they are often imperfect in producing a 
complete cure ; fo it is generally proper, and 
often neceffary, to attempt a more entire and 
certain cure by purgatives given by the mouth. 
The more powerful of thefe, or, as they are 
called, the Draflic Purgatives, may be fome- 
times neceffary ; but their ufe is to be avoid- 
ed, both becaufe they are apt to be rejected 
by vomiting, and becaufe when they do not 
fucceed in removing the obftruction they are 
ready to induce an inflammation. Upon this 
account it is ufual, and indeed proper, at leaft 
in the firft place, to employ the milder and 
lefs inflammatory purgatives. None have 
fucceeded with me better than the cryftals of 
tartar, becaufe this medicine may be conve- 
niently given, in fmall but repeated dofes, to 
a considerable quantity ; and under this man- 
agement it is the purgative leaft ready to be 
rejected by vomiting, and much lefs fo than 
the other neutral falts. If a ftronger purga- 
tive 



124 PRACTICE 

tive be required, jalap, properly prepared, is 
lefs offenfive to the palate, and fits better up- 
on the ftomach, than moft other powerful 
purgatives. On many occafions of colic, 
nothing is more effectually purgative than a 
large dofe of calomel. Some practitioners 
have attempted to remove the obftruttion of 
the interlines by antimonial emetics exhibited 
*in fmall dofes, repeated at proper intervals ; 
and when thefe dofes are not entirely rejected 
by vomiting, they often prove effectual pur- 
gatives. 

When every purgative has failed, the ac- 
tion of the interlines has been effectually ex- 
cited by throwing cold water on the lower 
extremities. 



MCCCCXLIX. 



The third means of overcoming the fpafm 
of the interlines in this difeafe, is by employ- 
ing a mechanical dilatation ; and it has been 
frequently fuppofed that quickfilver, given in 
large quantity, might operate in this manner. 
I have not, however, found it fuccefsful ; and 
the theory of it is with me very doubtful. 
Some authors have mentioned the ufe of gold 
and filver pills, or balls, fwallowed down ; but 
I have no experience of fuch practices, and I 
cannot fuppofe them a probable means of 
relief. 

MCCCCL. 



OF PHYSIC. 125 



MCCCCL. 

Another means of mechanical dilatation, 
and a more probable meafure, is by injecting 
a large quantity of warm water by a proper 
fyringe, which may throw it with fome force, 
and in a continued flream, into the rectum. 
Both from the experiments reported by the 
late Mr. De Haen, and from thofe I myfelf 
haye had occafion to make, I judge this rem- 
edy to be one of the mod powerful and ef^ 
fe&ual. 

MCCCCLI. 

I have now mentioned all the feveral means 
that may be- employed for the cure of the 
colic, confidered as a genus ; but before 1 
quit this fubjecl:, it may be expected that I 
Ihould take notice of fome of the fpecies 
which may feem to require a particular con- 
fideration. In this view it may be expected 
that I Ihould efpecially take notice of that 
fpecies named the Colic of Poitou, and par- 
ticularly known in England by the name of 
the Devonlhire Colic. 

MCCCCLII. 

This fpecies of the difeafe is certainly a 
peculiar one, both in refpecl; of its caufe and 
its effects ; but, as to the firft, it has been 

lately 



126 PRACTICE 

lately fo much the fubjeft of inve (ligation, 
and is fo well afcertained by the learned phy- 
ficians Sir George Barker and Dr. Hardy, 
that it is unneceffary for me to lay any thing 
cf it here. 

With refpe£l to the cure of it, fo far as it 
appears in the form of a colic, my want of ex- 
perience concerning it does not allow me to 
fpeak with any confidence on the fubjed ; 
but, fo far as I can learn from others, it ap- 
pears to me, that it is to be treated by all the 
ieveral means that I have propofed above for 
the cure of colic in general. 

How far the peculiar effe&s of this difeafe 
are to be certainly forefeen and obviated, I 
have not properly learned ; and I muil leave 
the matter to be determined by thofe who 
have had fufncient experience in it. 



Chap. X. 

Of the Cholera. 

MCCCCLIII. 

IN this difeafe, a vomiting and purging 
concurring together, or frequently alternating 
with one another, are the chief fymptoms. 

The 



OF PHYSIC. 127 

The matter rejected both upwards and down- 
wards appears manifeftly to confift chiefly of 
bile. 

MCCCCLIV. 

From this laft circumftance I conclude, 
that the difeafe depends upon an increafed 
fecretion of bile, and its copious eflfufion into 
the alimentary canal ; and, as in this it irri- 
tates and excites the motions above mention- 
ed, I infer, that the bile thus effufed in larger 
quantity is at the fame time alfo of a more 
acrid quality.. This appears like wife from 
the violent and very painful gripings that aU 
tend the difeafe, and which we can impute 
only to the violent fpafmodic contractions of 
the interlines that take plaC«, here. Thefe 
fpafms are commonly communicated to the 
abdominal mufcles, and very frequently to 
thofe of the extremities. 

MCCCCLV. 

In the manner now defcribed, the difeafe 
frequently proceeds with great violence, till 
the flrength of the patient is greatly, and often 
fuddenly, weakened ; while a coldnefs of the 
extremities, cold fweats, and faintings, coming 
on, an end is put to the patient's life, fome- 
times in the courfe of one day. In other 
cafes the difeafe is lefs violent, continues for a 
day or two, and then ceafes by degrees ; 

though 



128 PRACTICE 

though fuch recoveries feldom happen with- 
out the afliftance of remedies. 

MCCCCLVI. 

The attacks of this difeafe are feldom ac- 
companied with any fymptoms of pyrexia ; 
and though, during the courfe of it, both the 
pulfe and refpiration are hurried and irregu- 
lar, yet thefe fymptoms are generally fo en- 
tirely removed by the remedies that quiet the 
fpafmodic affections peculiar to the difeafe, 
as to leave no ground for fuppofing that it 
had been accompanied by any proper py- 
rexia. 

MCCCCLVII. 

This is a difeafe attending a very warm 
ftate of the air j and, in very warm climates, 
it may perhaps appear at any time of the 
year : But even in fuch climates it is moft 
frequent during their warmeft feafons ; and 
in temperate climates, it appears only in the 
warm feafons. Dr. Sydenham confidered 
the appearances of this difeafe in England 
to be confined to the month of Auguft ; 
but he himfelf obferved it to appear fome- 
times towards the end of fummer, when the 
feafon was unufually warm ; and that, in 
proportion to the heat, the violence of the 
difeafe was greater. Others have obferved 
that it appeared more early in fummer, and 

always 



OF PHYSIC. 129 

always fooner or later, according as the great 
heats fooner or later fet in. 

MCCCCLVIII. 

From all thefe circumftances, it is, I think, 
very evident, that this difeafe is the effecl of a 
warm atmofphere, producing fome change in 
the ftate of the bile in the human body : And 
the change may confift, either in the matter 
of the bile being rendered more acrid, and 
thereby fitted to excite a more copious fe- 
cretion ; or, in the fame matter, its being 
prepared to pafs off in larger quantity than 
ufual. 

MCCCCLIX. 

It has been remarked, that in warm cli- 
mates and feafons, after extremely hot and 
dry weather, a fall of rain cooling the atmof- 
phere feems especially to bring on this dif- 
eafe ; and it is very probable that an ob- 
ftru&ed perfpiration may have alfo a fhare in 
this, though it is alfo certain that the difeafe 
does appear when no change in the temper- 
ature of the air, nor any application of cold, 
has been obferved. 

MCCCCLX. 

It is poflible, that, in fome cafes, the heat 
t>f the feafon may give only a predifpofition, 

and 



*3° PRACTICE 

and that the difeafe may be excited by certain 
ingefla or other caufes ; but it is equally cer- 
tain, that the difeafe has occurred without 
any previous change or error, either in diet, 
or in the manner of life, that could be ob- 
ferved. 



MCCCCLXI. 

The Nofologifls have conftitutecl a Genus 
under the title of Cholera, and under this 
have arranged as fpecies every affe&ion in 
which a vomiting and purging of any kind 
happened to concur. In many of theie fpe- 
cies, however, the matter evacuated is not 
bilious ; nor does the evacuation proceed 
from any caufe in the Mate of the atmof- 
phere. Further, in many of thefe fpecies 
alfo, the vomiting which occurs is not an ef- 
fential, but merely an accidental fymptom 
from the particular violence of the ^difeafe. 
The appellation of Cholera therefore mould, 
in my opinion, be confined to the difeafe I 
have defcribed above ; which by its peculiar 
caufe, and perhaps alfo by its fymptoms, is 
Very different from all the other fpecies that 
have been affociated with it. I believe that 
all the other fpecies arranged under the title 
of Cholera by Sauvages or Sagar, may be 
properly enough referred to the genus of Di- 
arrhoea ; which we are to treat of in the next 
chapter. 

The 



OF PHYSIC. 131 

The diftin&ion I have endeavoured to 
eftablifh between the proper Cholera, and 
the other difeafes that have fometimes got 
the fame appellation, will, as I judge, fuper- 
fede the queflion, Whether the Cholera, in 
temperate climates, happens at any other 
feafon than that above affigned ? 

MCCCCLXII. 

In the cafe of a genuine cholera, the cure 
of it has been long eflablifhed by experience. 

In the beginning of the difeafe, the evacu- 
ation of the redundant bile is to be favoured 
by the plentiful exhibition of mild diluents, 
both given by the mouth, and injecled by the 
anus ; and all evacuant medicines, employed 
111 either way, are not only fuperfluous, but 
commonly hurtful. 

MCCCCLXIII. 

When the redundant bile appears to be 
fufficiently warned out, and even before that, 
if the fpafmodic anions of the alimentary 
canal become very violent, and are commu- 
nicated in a confiderable degree to other parts 
of the body, or when a dangerous debility 
ieems to be induced, the irritation is to be 
immediately obviated by opiates, in fufficient- 
ly large dofes, but in fmall bulk, and given 
either by the mouth or by glyfter. 

^MCCCCLXIV. 






132 PRACTICE 

MCCCCLXIV. 

Though the patient be in this manner re- 
lieved, it frequently happens, that when the 
operation of the opium is over, the difeafe 
mows a tendency to return ; and, for at leafl 
fome days after the firft attack, the irritabili- 
ty of the inteftines, and their difpofition to 
fall into painful fpafmodic contractions, feem 
to continue. In this fituation, the repetition 
of the opiates, for perhaps feveral days, may 
come to be necelTary ; and as the debility 
commonly induced by the difeafe favours the 
difpofition to fpafmodic affe&ions, it is often 
ufeful and necelfary, together with the opiates, 
to employ the tonic powers of the Peruvian 
bark. 



Chap. XI. 
Of Diarrhoea or Looseness* 

MCCCCLXV. 

THIS difeafe confifts in evacuations by 
{tool, more frequent and of more liquid mat- 
ter than uiual. This leading and chara&er- 
iflic fymptom is fo diverfified in its degree, in 
its caufes, and in the variety of matter evac- 

uatedj 



OF PHYSIC. 135 

Uated, that it is almofl impomble to give any 
general hiftory of the difeafe. 

MCCCCLXVI. 

It is to be diftinguifhed from dyfentery, by 
not being contagious ; by being generally 
without fever ; and by being with the evacu- 
tion of the natural excrements, which are, at 
leaft for fome timej retained in dyfentery. 
The two difeafes have been commonly diftin- 
guifhed by the gripings being more violent in 
the dyfentery ; and they are commonly lefs 
violent and Ms frequent in diarrhoea : But 
as they frequently do occur in this alfo, and 
fometimes to a confiderable degree, fo they 
do not afford any proper diflincnon. 

MCCCCLXVIL 

A diarrhoea is to be diflinguiihcd from 
cholera chiefly by the difference of their cauf- 
es ; which, in cholera, is of one peculiar kind ; 
but in diarrhoea is prodigioufly diverfified, as 
we (hall fee prefently. It has been common 
to diflinguifh cholera by the evacuation down- 
wards being of bilious matter, and by this be- 
ing always accompanied with a vomiting of 
the fame kind ; but it does not univerfally 
apply, as a diarrhoea is fometimes attended 
with vomiting, and even of bilious matter. 

Vol. III. G MCCCCLXVIli. 



i 3 4 PRACTICE 

MCCCCLXVIII. 

The difeafe of diarrhoea, thus diflinguifh- 
ed, is very greatly diver fined ; but in all cafes, 
the frequency of ilools is to be imputed to a 
preternatural increafe of the periftaltic mo- 
tion in the whole, or at leaft in a confiderable 
portion, of the inteflinal canal. This increaf- 
ed a&ion is in different degrees, is often con- 
vulfive and fpafmodic, and at any rate is a 
motus abnormis : For which reafon, in the 
Methodical Nofology, I have referred it to 
the order of Spafmi, and accordingly treat of 
it in this place. 

MCCCCLXIX. 

Upon the fame ground, as I confider the 
difeafe named Lientery to be an increafed 
periftaltic motion over the whole of the in- 
teflinal canal, arifing from a peculiar irrita- 
bility, I have cor fidered it as merely a fpecies 
of diarrhoea. The idea of a laxity of the in- 
teflinal canal being the caufe either of lientery, 
or other fpecies of diarrhoea, appears to me 
to be without foundation, except in the fingle 
cafe of frequent liquid (tools from a palfy of 
the. fphintter ani. 

MCCCCLXX. 

The increafed a£lion of the periftaltic mo- 
tion, I confider as always the chief part of the 

proximate 



OF PHYSIC. 135 

proximate caufe of diarrhoea : But the dif- 
eafe is further, and indeed chiefly, diverfified 
by the different caufes of this mcreafed ac- 
tion ; which we are now to inquire into. 



MCCCCLXXI. 

The feveral caufes of the increafed action 
of the interlines may be referred, I think, in 
the firft place, to two general heads. 

Thejirft is, of the difeafes of certain parts 
of the body which, cither from a confent of 
the inte £tines with thefe parts, or from the re- 
lation which the interlines have to the whole 
fyflem, occafion an increafed action in the 
inteilines, without the transference of any 
flimulant matter from the primary difeaied 
part to them. 

The fecond head of the caufes of the in- 
creafed action of the inteflines is of the flim- 
uli of various kinds, which are applied direct- 
ly to the inteilines themfelves. 



MCCCCLXXII. 

That afFections of other parts of the fyflem 
may affect the inteilines without the transfer- 
ence or application of any flimulant matter, 
we learn from hence, that the paflions of the 
mind do in fome perfons excite diarrhoea. 

G 2 MCCCCLXX1II. 



i 3 6 PRACTICE 

MCCCCLXXIII. 

That difeafes in other parts may in like 
manner affeft the inteftines, appears from the 
dentition of infants frequently exciting diar- 
rhoea. I believe that the gout often affords 
another inftance of the fame kind ; and prob- 
ably there are others alfo, though not well 
ascertained. 

MCCCCLXXIV. 

The ftimuli (MCCCCLXXI) which may 
be applied to the inteftines are of very various 
kinds ; and are either, 

1. Matters introduced by the mouth. 

2. Matters poured into the inteftines by 
the feveral excretories opening into them. 

3. Matters poured from certain preternat- 
ural openings made into them in certain dif* 
eafes. 

MCCCCLXXV. 

Of thofe (MCCCCLXXIV, 1.) introduce 
ed by the mouth, the firft tobe mentioned are 
the aliments commonly taken in. Too great 
a quantity of thefe taken in, often prevents 
their due digeftion in the ftomach ; and by 
being thus fent in their crude, and probably 
acrid, ftate to the inteftines, they frequently 
excite diarrhoea. 

The 



OF PHYSIC. 137 

The fame aliments, though in proper quan- 
tity, yet having too great a proportion, as fre- 
quently happens, of faline or faccharine mat- 
ter along with them, prove ftimulant to the 
inteftines, and excite diarrhoea. 

But our aliments prove efpecially the cauf- 
es of diarrhoea, according as they, from their 
own nature, or from the weaknefs of the florn- 
ach, are difpofed to undergo an undue de- 
gree of fermentation there, and thereby be- 
come ftimulant to the interlines. Thus acef- 
cent aliments are ready to produce diarrhoea ; 
but whether from their having any dire&ly 
purgative quality, or only as mixed in an 
over proportion with the bile, is not well de- 
termined. 

MCCCCLXXVI. 

Not only the acefcent, but alfo the putres- 
cent difpofition of the aliments, feems to oc- 
caiion a diarrhoea j and it appears that even 
the effluvia of putrid bodies, taken in any way 
in large quantity, have the fame effecl. 

Are oils or fats, taken in as a part of our 
aliments, ever the caufe of diarrhoea ? and if 
fo, in what manner do they operate ? 
1 
MCCCCLXXVII. 

The other matters introduced by the 

mouth, which may be caufes of diarrhoea, are 

thofe thrown in either as medicines, or poi- 

G 3 fons 



138 PRACTICE 

fons that have the faculty of ftimulating the 
alimentary canal. Thus, in the lift of the 
Materia Medica, we have a long catalogue of 
thofe named purgatives ; and in the lift of 
poifons, we have many poifefled of the fame 
quality. The former, given in a certain 
quantity, occafion a temporary diarrhoea ; 
and given in very large do<es, may occafion it 
in excefs, and continue it longer than ufual, 
producing that fpecies of diarrhoea named a 
Hypercatharfis. 

MCCCCLXXV1II. 

The matters (MCCCCLXXI V, 2.) pour- 
ed into the cavity of the interlines from the 
excretories opening into them, and which may 
occafion diarrhoea, are either thofe from the 
pancreatic or biliary duel;, or thofe from the 
excretories in the coats of the interlines them- 
felves. 

MC'CCCLXXIX. 

What changes may happen in the pancre- 
atic juice, I do not exactly know ; but I fup- 
pofe that an acrid fluid may iffue from the 
pancreas, even while ftill entire in its ftruc- 
ture ; but more efpecially, when it is in a fup- 
purated, fchirrous, or cancerous ftate, that a- 
very acrid matter may be poured out by the 
pancreatic du£l, and occafion diarrhoea. 

MCCCCLXXX. 



OF PHYSIC. 139 

MCCCCLXXX. 



We know well, that from the biliary duel: 
the bile may be poured out in greater quan- 
tity than ulual ; and there is little doubt of 
its being alio fometimes poured out of a more 
than ordinary acrid quality. It is very prob- 
able, that in both ways the bile is frequently 
a caufe of diarrhoea. 

Though I have faid above that diarrhoea 
may be commonly diftinguilhed from chol- 
era, I muft admit here, that as the caufes pro- 
ducing that ftate of the bile which occahons 
cholera, may occur in all the different poflible 
degrees of force, fo as, on one occalion, to 
produce the molt violent and diftinctly mark- 
ed cholera ; but, upon another, to produce 
only the gentleft diarrhoea ; which, however, 
will be the fame difeafe, only varying in de- 
gree : So I think it probable, that in warm 
climates, and in warm feafons, a diarrhtza bil~ 
iofa of this kind may frequently occur, not to 
be always certainly diflinguiihed from chol- 
era. 

However this may be, it is fufficiently 
probable, that, in fome cafes, the bile, with- 
out having been afted upon by *he heat of 
the climate or feafon, may be redundant and 
acrid, and prove therefore a particular caufe 
of diarrhoea. 

G4 MCCCCLXXXI. 



140 PRACTICE 

MCCCCLXXXI. 

Befide bile from the feveral caufes and in 
the conditions mentioned, the biliary dutt 
may pour out pus, or other matter, from ab- 
iceffes in the liver, which may be the caufe of 
diarrhoea. 

Practical writers take notice of a diarrhoea 
wherein a thin and bloody liquid is discharg- 
ed ; which they fuppofe to have proceeded 
from the liver, and have therefore given the 
difeafe the name of Hepatirrhcea : But we 
have not met with any inftance of this kind ; 
and therefore cannot properly fay any thing 
concerning it. 

MCCCCLXXXII. 

A fecond fet of excretories, from which 
matter is poured into the cavity of the intef- 
tines, are thofe from the coats of the interlines 
themfeives ; and are either the exhalants pro- 
ceeding direftly from the extremities of ar- 
teries, or the excretories from the mucous fol- 
licles : And both thefe fources occur in pro- 
digious number over the internal furface of 
the whole inteflinal canal. It is probable 
that it is chiefly the efFufion from thefe 
fources which, in moll inflances, gives the 
matter of the liquid ftools occurring in diar- 
rhoea. 

MCCCCLXXXIII. 



OF PHYSIC. 141 



MCCCCLXXX'III. * 

The matter from both fources may be pour- 
ed out in larger quantity than ufual, merely 
by the increafed action of the interlines, 
whether that be excited by the paflions of the 
mind (MCCCCXXII), by dileafes in other 
parts of the fyftem (MCCCCLXXI, i.j, 
or by the various ftimulants mentioned 
MCCCCLXXV, and following ; or the 
quantity of matter poured out may be in- 
creafed, not fo much by the increaled action 
of the inteflines, as by an increafed afflux of 
fluids from other parts of the fyftem. 

Thus, cold applied to the furface of the 
body, and fupprefling perfpiration, may de- 
termine a greater quantity of fluids to the in- 
teflines. 

Thus, in the ifchuria renalis, the urine tak- 
en into the bloodveflels is fometimes deter- 
mined to pafs off again by the interlines. 

In like manner, pus or ferum may be ab- 
sorbed from the cavities in which they have 
been ftagnant, and be again poured out into 
the inteflines, as frequently happens, in par- 
ticular with refpecl; to the water of dropfies. 

MCCCCLXXXIV. 

It is to be obferved here, that a diarrhoea 
may be excited not only by a copious afflux 
of fluids from other parts of the fyftem, but 

Vol. 3. G 5 likewife 



142 PRACTICE 

likewife by the mere determination of various 
acrid matters from the mafs of blood into the 
cavity of the inteftines. Thus it is fuppofed 
that the morbific matter of fevers is fometimes 
thrown out into the cavity of the inteftines, 
and gives a critical diarrhoea : And whether 
I do or do not admit the doctrine of critical 
evacuations, I think it is probable that the 
morbific matter of the exanthemata is fre- 
quently thrown upon the inteftines, and oc- 
cafions diarrhoea. 

MCCCCLXXXV. 

It is to me further probable, that the pu- 
trefcent matter diffufed over the mafs of blood 
in putrid difeafes, is frequently poured out 
by the exhalants into the inteftines, and 
proves there the caufe, at leaft in part, of 
the diarrhoea fo commonly attending thefe 
difeafes. 

MCCCCLXXXVI. 

Upon this fubjecl of the matters poured 
into the cavity of the inteftines, I have chief- 
ly confidered them as poured out in unufual 
quantity : But it is probable that, for the moft 
part, they are alfo changed in their quality, 
and become of a more acrid and ftimulant 
nature ; upon which account efpecially it is, 
that they excite, or at leaft increafe, a diar- 
rhoea. 

MCCCCLXXXVIL 



OF PHYSIC. 143 



MCCCCLXXXVII. 

How far, and in what manner, the exha- 
lant fluid may be changed in its nature and 
quality, we do not certainly know : But with 
refpecl: to the fluid from the mucous excre- 
tories, we know, that, when poured out in 
unufual quantity, it is commonly, at the fame 
time, in a more liquid and acrid form ; and 
may 'prove* therefore, confiderably irritating. 

MCCCCLXXXVIII. 

Though the copious effufion of a more 
liquid and acrid matter from the mucous ex- 
cretories, be probably owing to the matter 
being poured out immediately as it is fecreted 
from the blood into the mucous follicles, 
without being allowed to ftagnate in the lat- 
ter, fo as to acquire that milder quality and 
thicker confidence we commonly find in the 
mucus in its natural Hate ; and although we 
might fuppofe that the excretions of a thin 
and acrid fluid fhould always be the effecj of 
every determination to the mucous follicles,, 
and of every ftimulant applied to them ; yet 
it is certain, that the reverfe is fometimes the 
cafe ; and that, from the mucous follicles, 
there is frequently an increafed excretion of 
a mucus, which appears in its proper form of 
a mild, vifcid, and thickiih matter. This 
commonly occurs in the cafe of dyfentery ; 
G 6 and 



ii4 PRACTICE 

and it has been obferved to give a fpecies of 
diarrhoea, which has been properly named the 

Diarrhoea Mucofa. 

MCCCCLXXXIX. 

A third fource of matter poured into the 
cavity of the imeflines, and occafioning diar- 
rhoea (MCCCCLXXIV, 3.), is from thofe 
preternatural openings produced by difeafes 
in the interlines or neighbouring parts. Thus 
the bloodveflels on the internal lurface of the 
interlines may be opened by erofion, rupture, 
or anaflomofis, and pour into the cavity their 
blood, which, either by its quantity or by its 
acrimony, whether inherent, or acquired by 
flagnation, may fometimes give a diarrhoea 
evacuating bloody matter. This is what I 
think happens in that difeafe which has been 
called the Mclana or Morbus Niger. 

MCCCCXC. 

Another preternatural fource of matter 
poured into the cavity of the interlines, is the 
rupture of abfeefles feated either in the coats 
of the interlines themfelves, or in any of the 
contiguous vifcera, which, during an inflamed 
ftate, had formed an adhefion with fome part 
of the interlines. The matter thus poured 
into their cavity may be various ; purulent 
or fanious, or both together, mixed at the 
fame time with more or lefs of blood ; and 

in 



OF PHYSIC. 145 

in each of thefe ftates may be a caufe of diar- 
rhoea. 

MCCCCXCI. 

Amongft the ftimuli that may be directly 
applied to the inteftines, and which, by in- 
creafing their periftaltic motion, may occafion 
diarrhoea, I rauft not omit to mention worms, 
as having frequently that effect.. 

MCCCCXCII. 

I mull alfo mention here a ftate of the in- 
teftines, wherein their periftaltic motion is < 
preternaturally increafed, and a diarrhoea 
produced j and that is, when they are affeft- 
ed with an erythematic inflammation. With 
refpeci to the exiftence of fuch a ftate, and its 
occafioning diarrhoea, fee what is faid above 
in CCCXCVIII and following. Whether 
it is to be confidered as a particular and dif- 
tintt cafe of diarrhoea, or is always the fame 
with fome of thofe produced by one or other 
of the caufes above mentioned, I have not 
been able to determine. 

MCCCCXCIII. 

Laftly, by a*i accumulation of alimentary 
or of other matter poured into the cavity of 
the inteftines from frveral of the fources above 
mentioned, a diarrhoea may be efpecially oc- 

cafioned 



146 PRACTICE 

cafioned when the abforption of the la&eals,. 
or of other abforbents, is prevented, either by 
an obftruclion of their orifices, or by an ob- 
ftru&ion of the mesenteric glands, through 
which alone the abforbed fluids can be tranf- 
mitted. 

In one inftance of this kind, when the chyle 
prepared in the ftomach and duodenum is 
not abforbed in the courfe of the inteftines, 
but panes off in confiderable quantity by the 
anus, the difeafe has been named Morbus CzL 
iacus, or fimply and more properly Cozliaca ; 
which accordingly I have confidered as a fpe- 
cies of diarrhoea. 

MCCCCXCIV. 

I have thus endeavoured to point out the 
various fpecies of difeafe that may come un- 
der the general appellation of Diarrhoea ; and 
from that enumeration it will appear, that 
many, and indeed the greater part of the cafes 
of diarrhoea, are to be confidered as fympa- 
thetic afre&ions, and to be cured only by 
curing the primary difeafe upon which they 
depend ; of which, however, I cannot prop- 
erly treat here. From our enumeration it 
will alfo appear, that many of the cafes of di- 
arrhoea which may be confidered as idiopath- 
ic, will not require my faying much of them 
here. In many inftances, the difeafe is as- 
certained, and alfo the caufe affigned, by the 
condition of the matter evacuated ; fo that 

what 



OF PHYSIC. 147 

what is neceffary to correct or remove it will 
be fufficiently obvious to practitioners of any 
knowledge. In fhort, I do not find that I 
can offer any general plan for the cure of di- 
arrhoea ; and all that I can propofe to do on 
this fubjett, is to give fome general remarks 
on the practice that has been commonly fol- 
lowed in the cure of this difeafe. 

MCCCCXCV. 

The practice in this difeafe has chiefly pro- 
ceeded upon the fuppofition of an acrimony 
in the fluids, or of a laxity in the fimple and 
moving fibres of the inteftines ; and the rem- 
edies employed have accordingly been, Cor- 
rectors of particular acrimony, general de- 
mulcents, evacuants by vomiting or purging, 
aftringents, or opiates. Upon each of thele 
kinds of remedy I fhall now offer fome re- 
marks. 

MCCCCXCVI. 

An acid acrimony is, upon feveral occa- 
fions, the caufe of diarrhoea, particularly in 
children ; and in fuch cafes the abforbent 
earths have been very properly employed. 
The common, however, ar 1 promifcuous ufe 
of thefe, has been Very injudicious ; and 
where there is any putrefcency, they muft be 
hurtful. 

MCCCCXCVII. 



148 PRACTICE 



MCCCCXCVII. 

The cafes in which there is a putrid or pu- 
trefcent acrimony prevailing, have been, I 
think, too feldom taken notice of ; and, there- 
fore, the ufe of acids too feldom admitted. 
The acrimony to be fu (peeled in bilious cafes, 
is probably of the putrefcent kind. 

MCCCCXCVIII. 

The general correctors of acrimony are the 
mild diluents and demulcents. The former 
have not been fo much employed in diarrhoea 
as they ought ; for, joined with demulcents, 
they very much increafe the effects of the 
latter : And although the demulcents, both 
mucilaginous and oily, may by thcmfelves be 
ufeful, yet without the affiftance of diluents 
they can hardly be introduced in fuch quan- 
tity as to anfwer the purpofe. 

MCCCCXCIX. 

As indigeftion and crudities prefent in the 
flomach, are fo often the caufe of diarrhoea, 
vomiting muft therefore be frequently very 
ufeful in this difeafe. 

In like manner, when the difeafe proceeds, 
as it often does, from obftructed perlpiration, 
and increafed afflux of fluids to the inteflines, 
vomiting is perhaps the mod effedual means 

of 



OF PHYSIC. 149 

of reftoring the determination of the fluids to 
the furface of the body. 

It is poffible alfo, that vomiting may give 
fome inverfion of the periftaltic motion, which 
is determined too much downwards in diar- 
rhoea ; fo that upon the whole it is a remedy 
which may be very generally ufeful in this 
difeafe. 

MD. 

Purging has been fuppofed to be more uni- 
verfally neceffary, and has been more gen- 
erally prattifed. This, however, in my opin- 
ion, proceeds upon very miftaken notions 
with refpect to the difeafe ; and fuch a prac- 
tice feems to me for the moft part fuperflu- 
ous, and in many cafes very hurtful. It goes 
upon the fuppofition of an acrimony prefent 
in the inteftines, that ought to be carried out 
by purging : But, if that acrimony has either 
been introduced by the mouth, or brought 
into the inteftines from other parts of the 
body, purging can neither be a means of cor- 
recting nor of exhaufting it ; and muft rather 
have the effeft of increafmg its afflux, and of 
aggravating its effe&s. From whatever fource 
the acrimony which can excite a diarrhoea 
proceeds, it may be fuppofed fufficient to 
evacuate itfelf, fo far as that can be done by 
purging ; and as in cholera, fo in the fame 
kind of diarrhoea, it will be more proper to 
aflifl the evacuation by diluents and demul- 
cents, 



150 PRACTICE 

cents, than to increafe the irritation by pur- 
gatives. 

MDI. 

If, then, the ufe of purgatives in diarrhoea 
may be confidered, even when an acrimony is 
prefent, as fuperfluous, there are many other 
cafes in which it may be extremely hurtful. 
If tli£ in it ability of the interlines mall, from 
affecl.ions in other parts of the fy flem, or other 
caufes, have oeen already very much increaf- 
ed, purgatives mud neceflarily aggravate the 
difeafe. In the cafe of lientery, nobody 
thinks of giving a purgative ; and in many 
cafes of diarrhoea approaching to that, they 
muft be equally improper. I have already 
obferved, that when diarrhoea proceeds from 
an afflux of fluids to the interlines, whether 
in too great quantity, or of an acrid quality, 
purgatives may be hurtful ; and whoever, 
therefore confiders the numerous and various 
fources from which acrid matter may be pour- 
ed into the cavity of the interlines, will readi- 
ly perceive, that, in many cafes of diarrhoea, 
purgatives may be extremely pernicious. 

There is one cafe in particular to be taken 
notice of. When, from a general and acrid 
diffolution of the blood, the ferous fluids run 
off too copioufly into the cavity of the intef- 
tines, and excite that diarrhoea which attends 
the advanced flate of hectic fever, and is prop- 
erly called a Colliquative Diarrhoea ; I have, 

in 



OF PHYSIC. 151 

in fuch cafes, often feen purgatives given with 
the moft baneful efFe&s. 

There is (till another cafe of diarrhoea in 
which purgatives are pernicious ; and that is, 
when the difeafe depends, as we have alleged 
it fometimes may, upon an erythematic in- 
flammation of the inteftines. 

I need hardly add, that if there he a cafe 
of diarrhoea depending upon a laxity of the 
folids, purgatives cannot there be of any fer- 
vice, and may do much harm. Upon the 
whole, it will, I think, appear, that the ufe of 
purgatives in diarrhoea is very much limited ; 
and that the promifcuous ufe of them, which 
has been fo common, is injudicious, and often 
pernicious. I believe the practice has been 
chiefly owing to the ufe of purgatives in dyf- 
enteric cafes, in which they are truly ufeful ; 
becaufe, contrary to the cafe of diarrhoea, 
there is in dyfentery a confiderable conftric- 
tion of the inteftines. 

MDII. 

Another fet of remedies employed in diar- 
rhoea are aftringents. There has been fome 
hefitation about the employment of thefe in 
recent cafes, upon the fuppofition that they 
might occafion the retention of an acrid mat- 
ter that fhould be thrown out. I cannot, 
however, well underfland or affign the cafes 
in which fuch caution is neceflary ; and I 
think that the power of aftringents is feldom 

fo 



152 PRACTICE 

fo great as to render their ufe very danger, 
ous. 

The only difficulty which has occurred to 
me, with refpecl to their ufe, has been to 
judge of the circumfiances to which they are 
efpecially adapted. It appears to me to be 
only in thofe where the irritability of the in, 
teflines depends upon a lofs of tone : And 
this, I think, may occur either from the de- 
bility of the whole fyftem, or from caufes act- 
ing on the interlines alone. All violent or 
long continued fpafmodic and convulfive af- 
fections of the inteftinal canal neceffarily in- 
duce a debility there ; and fuch caufes often 
take place, from violent irritation, in colic^ 
dyfentery, cholera, and diarrhoea. 

MDIII. 

The Iaft of the remedies of diarrhoea that 
remain to be mentioned are opiates. The 
fame objections have been made to the ufe of 
thefe, in recent cafes of diarrhoea, as to that 
of aftringents ; but on no good grounds : For 
the effect; of opiates, as aftringent, is never 
very permanent ; and an evacuation depend- 
ing upon irritation, though it may be for 
fome time fufpended by opiates, yet always 
returns very foon. It is only by taking off 
irritability that opiates are ufeful in diarrhoea ; 
and therefore, when the difeafe depends upon 
an increafe of irritability alone, or when, 
though proceeding from irritation, that irri- 
tation 



OF PHYSIC. 153 

tation is corre&ed or exhaufted, opiates are 
the moft ufeful and certain remedy. And 
though opiates are not fuited to correcT; or re- 
move an irritation applied, they are often of 
great benefit in fufpending the efFe&s of that 
irritation whenever thefe are violent : And, 
upon the whole, it will appear, that opiates 
may be very frequently, and with great pro- 
priety, employed in the cure of diarrhoea, 



Chap. XII. 
Of the Diabetes. 

MDIV. 

THIS difeafe confifts in the voiding of aft 
unufually large quantity of urine. 

As hardly any fecretion can be increafed 
tvithout an increafed action of the vefTels con- 
cerned in it, and as fome inftances of this dif- 
eafe are attended with affe&ions manifeftly 
fpafmodic, I have had no doubt of arranging 
the diabetes under the order of Spafmi. 

MDV. 

This difeafe is always accompanied with & 
&reat degree of thirft, and therefore with the. 

taking 



i 5 4 PRACTICE 

taking in of a great quantity of drink. This 
in fome meafure accounts for the very extra- 
ordinary quantities of urine voided : But 
ftill, independent of this, a peculiar difeafe 
certainly takes place ; as the quantity of urine 
voided does almoft always exceed the whole 
of the liquids, and fometimes the whole of 
both folids and liquids, taken in. 

MDVI. 

The urine voided in this difeafe is always 
very clear, and at firfb fight appears entirely 
without any colour ; but viewed in a certain 
light, it generally appears to be nightly tinged 
with a yellowifh green, and in this refpect has 
been very properly compared to a folution of 
honey in a large proportion of water. 

Examined by the tafle, it is very generally 
found to be more or lefs fweet ; and many ex- 
periments that have now been made in dif- 
ferent inflances of the difeafe fhow clearly 
that fuch urine contains, in confiderable 
quantity, a faccharine matter which appears 
to be very exactly of the nature of common 



fugar. 



MDVII. 



Doftor Willis fecms to me to have been 
the firfl who took notice of the fweetnefs of 
the urine in diabetes, and almoft every phy- 
fician of England has fmce taken notice of 

the 



OF PHYSIC. 155 

the fame. It is to be doubted, indeed, if 
there is any cafe of idiopathic diabetes in 
which the urine is of a different kind. 
Though neither the ancients, nor, in the oth- 
er countries of Europe, the moderns, till the 
latter were directed to it by the Englifh, have 
taken notice of the fweetnefs of the urine, it 
does not perfuade me, that either in ancient 
or in modern times the urine in diabetes was 
of another kind. I myfelf, indeed, think I 
have met with one inflance of diabetes in 
which the urine was perfectly infipid ; and it 
would feem that a like obfervation had oc- 
curred to Dr. Martin Lifter. I am perfuad- 
ed, however, that fuch inftances are very rare ; 
and that the other is by much the more com- 
mon, and perhaps the almoil univerfal occur- 
rence. I judge, therefore, that the prefence 
of fuch a faccharine matter may be confidered 
as the principal circumftance in idiopathic 
diabetes ; and it gives at leaft the only cafe 
of that difeafe that I can properly treat of 
here, for I am only certain that what I am 
further to mention relates to fuch a cafe. 

MDVIII. 

The antecedents of this difeafe, and confe- 
quently the remote caufes of it, have not been 
well afcertained. It may be true that it fre- 
quently happens to men who, for a long time 
before, had been intemperate in drinking ; 
that it happens to perfons of a broken confti- 

tution, 



i 5 5 PRACTICE 

tution, or who, as we often exprefs it, are in 
a cachectic flate ; that it fometimes follows in- 
termittent fevers ; and that it has often oc- 
curred from excefs in the drinking of min- 
eral waters. But none of thefe caufes apply 
very generally to the cafes that occur : Such 
cafes are not always, nor even frequently, fol- 
lowed by a diabetes ; and there are many in- 
stances of diabetes which could not be refer- 
red to any of them. In moil; of the cafes of 
this difeafe which I have met with, I could 
not refer it to any particular caufe. 



MDIX. 

This difeafe commonly tomes on Howly, 
and almofl imperceptibly, without any pre- 
vious diforder. It often arifes to a confider- 
able degree, and fubfifls long without being 
accompanied with evident diforder in any 
particular part of the fyftem. The great 
thirft which always, and the voracious appe- 
tite which frequently, occurs in it, are often 
the only remarkable fymptoms. Under the 
continuance of the difeafe, the body is often 
greatly emaciated ; and a great weaknefs alfo 
prevails. The pulfe is commonly frequent ; 
and an obfcure fever is for the moft part pref- 
ent. When the difeafe proves fatal, it gen- 
erally ends with a fever, in many circum- 
ftances, particularly thofe of emaciation and 
debility, refembling a hectic* 

MDX. 



OF PHYSIC. 157 

MDX. 

The proximate caufe of this difeafe is not 
certainly or clearly known. It feems to have 
been fometimes connected with calculous af- 
fections of the kidneys ; and it is poflible, 
that an irritation applied there may increafe 
the fecretion of urine. It perhaps often does 
fo ; but how it ihould produce the lingular 
change that takes place in the ftate of the 
urine, is not to be eaiily explained. It cer- 
tainly often happens, that calculous matters 
are long prefent in the urinary paffages, with- 
out having any fuch effe6l as that of produc- 
ing diabetes in any {hape. 

Some have fuppofed that the difeafe oc- 
curs from a relaxed ftate of the fecretory vef- 
lels of the kidneys ; and indeed the diffec"lions 
of perfons who had died of this difeafe have 
fhown the kidneys in a very flaccid ftate. 
This, however, is probably to be confidered 
as rather the effect than the caufe of the 
difeafe. 

That no topical affe&ion of the kidneys has 
a fhare in producing this difeafe, and that a 
fault in the a (limitation of the fluids is rather 
to be blamed, I conclude from hence, that 
even the lolid food taken in, increafes the 
quantity of the urine voided, at the fame time 
with an increafe of the faccharine matter 
above mentioned. 

Vol. III. . H MDXI. 



1*8 PRACTICE 



MDXI. 

The diabetes has been fuppofed to be ow- 
ing to a certain ftate of the bile ; and it is 
true, that this difeafe has fometimes occurred 
in perfons who were at the fame time affe&ed 
with difeafes of the liver : But this concur- 
rence does not often take place j and the dia- 
betes frequently occurs feparately from any 
affection of the liver. In twenty inftances of 
diabetes which I have feen, there was not in 
any one of them any evident affection of the 
liver. 

The explanation that has been offered of 
the nature and operation of the bile, in pro- 
ducing diabetes, is very hypothetical, and no 
wife fatisfying. 

MDXII. 

As I have already faid, I think it probable, 
that in moft cafes the proximate caufe of this 
difeafe is fome fault in the affimilatory powers, 
or in thofe employed in converting aliment- 
ary matters into the proper animal fluids. 
This I formerly hinted to Dr. Dobfon, and it 
has been profecuted and publifhed by him ; 
but I muff own, that it is a theory embarrafT- 
ed with fome difficulties which I cannot at 
prefent very well remove. 

MDXIII. 



OF PHYSIC. 159 



MDXIII. 

The proximate caufe of diabetes being Co 
little known or ascertained, I cannot propofe 
any rational method of cure in the difeafe. 
From the teftimony of feveral authors, I be- 
lieve that the difeafe has been cured : But I 
believe alfo, that this has feldom happened ; 
and when the difeafe has been cured, I doubt 
much if it was efFe&ed by the feveral reme- 
dies to which thefe cures have been afcribed. 
In all the mftances of this difeafe which I my- 
felf iiave feen, and in feveral others of which 
I have been informed, no cure of it has ever 
be .in made in Scotland, though many inftances 
of it have occurred, and in mod of them the 
remedies recommended by authors have been 
diligently employed. I cannot, therefore, 
with any advantage, enter into a detail of thefe 
remedies ; and as the difeafe, together with 
its feveral circum fiances, when they mail 
hereafter occur, is likely to become the fub- 
jecl: of diligent inveftigation, I avoid going 
farther at prefent, and judge it prudent to 
fufpend my opinion till I fhall have more ob- 
fervations and experiments upon which I can 
form it more clearly. 



H2 



HAP, 



i6o PRACTICE 



HAP, XIII. 



Of the Hysteria, or the Hysteric Dis- 
ease. 



. MDXIV. 

THE many and various fymptoms which 
have been fuppofed to belong to a difeafe un- 
der this appellation, render it extremely dif- 
ficult to give a general character or definition 
of it. It is, however, proper in all cafes to 
attempt fome general idea ; and therefore, by 
taking the moll common form, and that con- 
currence of fymptoms by which it is princi- 
pally diftinguifhed, I have formed a charac- 
ter in my fyftem of Methodical Nofology, and 
ftiall here endeavour to illuftrate it by giving 
a more full hiftory of the phenomena. 

MDXV. 

The difeafe attacks in paroxyfms or fits. 
Thefe commonly begin by fome pain and ful- 
nefs felt in the left fide of the belly. From 
this a ball feems to move with a grumbling 
noife into the other parts of the belly ; and, 
making as it were various convolutions there, 
feems to move into the ftomach ; and more 

diftinctJy 



OF PHYSIC. 161 

diftin&ly ftill rifes up to the top of the gullet, 
where it remains for fome time, and by its 
preiTure upon the larynx gives a fenfe of fuf- 
focation. By the time that the difeafe has 
proceeded thus far, the patient is affe&ed 
with a flupor and infenfibility, while at the 
fame time the body is agitated with various 
convulfions. The trunk of the body is 
wreathed to and fro, and the limbs are va- 
rioufly agitated ; commonly the convulfive 
motion of one arm and hand, is that of beat- 
ing, with the clofed fill, upon the breafl very 
violently and repeatedly. This (late contin- 
ues for fome time, and has during that time 
fome remiffions and renewals of the convul- 
five motions ; but they at length ceafe, leav-* 
ing the patient in a ftupid and feemingly 
fleeping (late. More or lefs fuddenly, and 
frequently with repeated fighing and fobbing, 
together with a murmuring noife in the belly, 
the patient returns to the exercife of fenfe and 
motion, but generally without any recollec- 
tion of the feveral circumftances that had 
taken place during the fit. 

MDXVI. 

This is the form of what is called an hyjlerk 
faroxyfm, and is the moll common form ; but 
its paroxyfms are confiderably varied in dif- 
ferent perfons, and even in the fame perfon 
at different times. It differs, by having more 
or fewer of the circumftances above mention- 
H 3 ed ; 



i62 PRACTICE 

cd ; by thefe circumftances being more or 
lefs violent ; and by the different duration of 
the whole fit. 

Before the fit, there is fometimes a iudden 
and unufually large flow of limpid urine. At 
the coming on of the fit, the {lomach is fome- 
times arFeded with vomiting, the lungs with 
confiderable difficulty of breathing, and the 
heart with palpitations. During the fit, the 
whole of the belly, and particularly the navel, 
is drawn ftrongly inwards ; the fphinder am 
is fometimes fo firmly conftriaed as not to 
admit a fmall glyfter pipe, and there is at the 
fame time an entire fuppreffion of urine. 
Such fits are, from time to time, ready to re- 
cur ; and duiing the intervals, the patients are 
liable to involuntary motions, to fits of laugh- 
ing and crying, with fudden tranfitions from 
the one to the other ; while fometimes falfe 
imaginations, and fome degree of delirium, 
alfo occur. 

MDXVII. 

Thefe affe&ions have been fuppofed pecu- 
liar to the female fex ; and indeed they moll 
commonly appear in females : But they fome- 
times, though rarely, attack alfo the male 
fex ; never, however, that I have obferved, in 
the fame exquifite degree. 

In the female fex, the difeafe occurs efpec- 
ially from the age of puberty to that of thirty 
five years j and though it does fometimes, yet 

very 



OF PHYSIC. 163 

very feldom appears before the former or 
after the latter of thefe periods. 

At all ages, the time at which it moft read- 
ily occurs is that of the menftrual period. 

The difeafe more efpecially affeds the.fc- 
males of the moft exquifitely fanguine and 
plethoric habits, and frequently aflteas thole 
of the moft robuft and mafculme conftitu- 

It affe6ts the barren more than the breed- 
ing women, and therefore frequently young 
widows. 

It occurs efpecially in thofe females who 
are liable to the Nymphomania ; and the 
Nofologifts have properly enough marked 
one of ihe varieties of this difeafe by the title 
of Hyfteria Libidinofa; 

In the perfons liable to the fits of this dif- 
eafe, it is readily excited by the paflions of 
the mind, and by every confiderable emotion, 
efpecially thofe brought on by furprife. 

The perfons liable to this difeafe acquire 
often fuch a degree of fenfibility, as to be 
ftrongly affeaed by every impreffion that 
comes upon them by furprife. 

MDXVIII. 

In this hiftory, there appears to be a con- 
currence of fymptoms andcircumftances prop- 
erly marking a very particular difeafe, which 
I think may be diftinguifhed from all others. 
It feems to me to have been improperly con- 
H 4 fidered 



16*4 PRACTICE 

fidered by phyficians as the fame with fome 
other difeafes, and particularly with hypo- 
chondriacs. The two difeafes may have 
fome fymptoms in common, but for the molt 
part are confiderably different. 

Spafmodic affections occur in both difeaf- 
es ; but neither fo frequently, nor to fo great 
a degree, in hypochondriacs as in hyfteria. 

Perfons liable to hyfteria are fometimes af- 
fected at the fame time with dyfpepfia. They 
are often, however, entirely free from it ; but 
I believe this never happens to perfons af- 
fected with hypochondriacs. 

Thefe different circum fiances mark fome 
difference in the two difeafes ; but they are 
ftill more certainly diftinguifhed by the tem- 
perament they attack, and by the time of life 
at which they appear to be mofl exquifttely 
formed. 

It has been generally fuppofed, that the 
two difeafes differ only in refpecl of their ap- 
pearing in different fexes. But this is not 
well founded : For although the hyfteria ap- 
pears mofl commonly in females, the male 
fex is not abfolutely free from it, as I have 
obferved above ; and although the hypochon- 
driacs may be mofl frequent in men, the in- 
ilances of it in the female fex are very common. 

MDXIX. 

From all thefe confiderations, it mull, I 
think, appear, that the hyfteria may be very 

well, 



O'F PHYSIC. 165 

well, and properly, diftinguimed from hypo- 
chondriafis. 

Further, it feems to me to have been with 
great impropriety, that almoft every degree of 
the irregular motions of the nervous fyftem 
has been referred to the one or other of thefe 
two difeafes. Both are marked by a pecu- 
liarity of temperament, as well as by certain 
fymptoms commonly accompanying that ; but 
fome of thefe, and many others ufually mark- 
ed by the name of nervous fymptoms, may, 
from various caufes, arife in temperaments 
different from that which is peculiar to either 
hyfleria or hypochondriafis, and without be- 
ing joined with the peculiar fymptoms of ei- 
ther the one or the other difeafe : So that the 
appellations of Hyfteric and Hypochondriac 
are very inaccurately applied to them. Un- 
der what view thefe fymptoms are otherwife 
to be confidered, I am not ready to deter- 
mine ; but muff remark, that the appellation 
of Nervous Difeafes is too vague and unde- 
fined to be of any ufeful application. 

MDXX. 

Having thus endeavoured to diftinguifh 
hyfteria from every other difeafe, I fhall now 
attempt its peculiar pathology. With refpefct 
to this, I think it will, in the firft place, be 
obvious, that its paroxyfms begin by a con- 
vulfive and fpafmodic affe&ion of the alimen- 
tary canal, which is afterwards communicated 

Vol. 3. * H 5 to 



166 PRACTICE 

to the brain, and to a great part of the nervous 
fyftem. Although the difeafe appears to be- 
gin in the alimentary canal, yet the connexion 
which the paroxyfms fo often have with the 
menftrual flux, and with the difeafes that de- 
pend on the ftate of the genitals, mows, that 
the phyficians have at all times judged rightly 
in confidering .this difeafe as an affection of 
.the uterus and other parts of the genital 
fyftem. 

MDXXI. 

With regard to this, however, I can go no 
farther. In what manner the uterus, and in 
particular the ovaria, are affected in this dif- 
eafe ; how the affection of thefe is communi- 
cated, with particular circumftances, to the 
alimentary canal j or how the affection of this, 
rifing upwards, affects the brain, fo as to oc- 
cafion the particular convulfions which occur 
in this difeafe, I cannot pretend to explain. 

But although I cannot trace this difeafe to 
its firft caufes, or explain the whole of the 
phenomena, I hope, that with refpect to the 
general nature of the difeafe, I may form fome 
general conclufions, which may ferve to direcl 
our conduct in the cure of it. 

MDXXII. 

Thus, from a confideration of the predifpo- 
nentand occahonal caufes, it will, I think, ap- 

v 'pear, 



OF PHYSIC. 167 

pear, that the chief part of the proximate 
caufe is a mobility of the fyftem, depending 
generally upon its plethoric ftate. 



MDXXIII. 



Whether this difeafe ever arifes from a mo- 
bility of the fyftem, independent of any ple- 
thoric ftate of it, I cannot pofitively deter- 
mine ; but in many cafes that have lubfjfted 
for fome time, it is evident that a fenfibility, 
and confequently a mobility, are acquired, 
which often appear when neither a general 
plethora can be fuppofed to fubfift, nor an 
occafional turgefcence to have happened. 
However, as we have mown above, that a dif- 
tention of theveffels of the brain feems to oc- 
cafion epilepfy, and that a turgefcence of the 
blood in the veffels of the lungs feems to pro- 
duce afthma ; fo analogy leads me to fuppole, 
that a turgefcence of blood in the uterus, 
or in other parts of the genital fyftem, may 
occafion the fpafmodic and convulfive mo- 
tions which appear in hyfteria. It will, at 
the fame time, be evident, that this affe&ion 
of the genitals muft especially occur in ple- 
thoric habits ; and every circumftance men- 
tioned in the hiftory of the difeafe ferves to 
confirm this opinion with refpedt to its prox- 
imate caufe. 

H6 MDXX1V. 



63 PRACTICE 



MDXXIV. 

From this view of the fubjecl:, the analogy 
of hyfteria and epilepfy will readily appear; 
and why, therefore, I am to fay that the indi- 
cations of cure are the fame in both. 

As the indications, fo the feveral means of 
anfwering them, are fo much the fame in both 
Vlifeafes, that the fame obfervations and di- 
rections, with regard to the choice and em- 
ployment of thefe remedies, that have been 
delivered above on the fubjecl; of epilepfy, 
will apply pretty exactly to hyfteria ; and 
therefore need not to be repeated here. 



Chap. IX. 

Of Canine Madness and Hydrophobia. 

MDXXV. 

THIS difeafe has been fo exactly and fully 
defcribed in books that are in every body's 
hands, that it is on no account neceflary for 
me to give any hiftory of it here ; and with 
refpect to the pathology of it, I find that I 
can fay nothing fatisfying to myfelf, or that I 
can expect to prove fo to others. I find alfo, 

with 



OF PHYSIC. 169 

with refpecl to the cure of this difeafe, that 
there is no fubjedt in which the fallacy of ex- 
perience appears more flrongly than in this. 
From the moll ancient to the prefent times, 
many remedies for preventing and curing this 
difeafe have been recommended under the 
fan&ion of pretended experience, and have 
perhaps alfo kept their credit for fome time : 
But fucceeding times have generally, upon the 
fame ground of experience, deftroyed that 
credit entirely ; and moll of the remedies for- 
merly employed are now fallen into abfolute 
neglect. In the prefent age, fome new rem- 
edies have been propofed, and have expe- 
rience alleged to vouch for their efficacy ; but 
many doubts Hill remain with refpecl: to this : 
and though I cannot determine in this matter 
from my own experience, I think it incum- 
bent on me to give the bell judgment I can 
form with refpecl; to the choice of the reme- 
dies at prefent recommended. 

MDXXVI. 

I am, in the firfl place, firmly perfuaded, 
that the moft certain means of preventing the 
confequences of the bite, is to cut out, or oth- 
erwife deftroy, the part in which the bite has 
been made. In this every body agrees ; but 
with this difference, that fome are of opinion 
that it can only be effectual when it is done 
very foon after the wound has been made, and 
they therefore neglett it when this opportu- 
nity 



i 7 o PRACTICE, &c. 

nity is miffed. There have been, however, 
no experiments made proper to determine 
this matter : And there are many considera- 
tions which lead me to think, that the poifon 
is not immediately communicated to the fyf- 
tem ; and therefore, that this meafure of de- 
ftroying the part may be practifed with ad*, 
vantage, even many days after the bite has 
been given. 

MDXXVII. 

Whilft the ftate of our experience, with 
refpect to feveral remedies now in ufe, is un- 
certain, I cannot venture to affert that any 
of thefe is abfolutely ineffectual ; but I can 
give it as my opinion, that the efficacy of 
mercury, given very largely, and per filled in 
for a long time, both as a means of prevent- 
ing the difeafe, and of curing it when it has 
actually come on, is better fupported by ex- 
perience than that of any other remedy now 
propofed, or commonly employed. 



BOOK 



1 7 1 




BOOK IV. 

of VESANLE, or of the DISOR- 
DERS of the INTELLECTUAL 
FUNCTIONS. 

CHAP. I. 

OF VESANI^T IN GENERAL. 

MDXXVIII. 

1HE Nofologifts, Sauvages 
and Sagar, in a clafs of difeafes under the 
title of Vesani£, have comprehended the 
two orders, of Hallucinations or Falfe Per- 
ceptions, and of Morojitata or Erroneous 
Appetites and Paffions ; and in like manner, 
Linnaeus in his clafs of Mentales, correl- 
ponding to the Vefaniaz of Sauvages, has com- 
prehended the two ordets of J?nagiriani and 

Paihetici, 



172 PRACTICE 

Pathetici, nearly the fame with the Halluci- 
nationes and Morofitates of that author. 
This, however, from feveral conliderations, 
appears to me improper ; and I have there- 
fore formed a clafs of Vefaniae nearly the 
fame with the Paranoias of Vogel, excluding 
from it the Hallucinationes and Morofitates, 
which I have referred to the Morbi Locales. 
Mr. Vogel has done the like, in feparating 
from the Paranoiae the falfe perceptions and 
erroneous appetites ; and has thrown .thefe 
into another clafs, to which he has given the 
title of Hyperaefthefes. 

MDXXIX. 

It is indeed true, that certain hallucinationes 
and morofitates are frequently combined with 
what I propofe to consider as ftriftly a vefa- 
nia or an erroneous judgment ; and fome- 
times the hallucinationes feem to lay the foun- 
dation of, and to form almofl entirely, the 
vefania. But as moft part of the hallucina- 
tiones enumerated by the Nofologifts are af- 
fections purely topical, and induce no other 
error of judgment befide that which relates to 
the fingle objecT: of the fenfe or particular or- 
gan affecled ; fo thefe are certainly to be fep- 
arated from the difeafes which confift in a 
more general affection of the judgment. 
Even when the hallucinationes conflantly ac- 
company or feem to induce the vefania, yet 
being fuch as arife from internal caufes, and 

may 



OF PHYSIC. 173 

may be prefumed to arife from the fame caufe 
as the more general affection of the judgment, 
they are therefore to be confidercd as fymp- 
toms of this only. 

In like manner I judge with refpect to the 
morofitates, or erroneous paflions, that ac- 
company vefania ; which, as confequences of 
a falfe judgment, muft be confidered as arifmg 
from the fame caufes, and as fymptoms only, 
of the more general affection. 

There is, indeed, one cafe of a morofitas 
which feems to induce a vefania, or more gen- 
eral affection of the judgment ; and this may 
lead us to confider the vefania, in this cafe, as 
a fymptom of an erroneous appetite, but will 
not afford any good reafon for comprehend- 
ing the morofitates in general under the ve- 
faniae, confidered as primary difeafes. 

The limitation, therefore, of the clafs of 
Vefaniae to the lefions of our judging fac- 
ulty, feems from every consideration to be 
proper. 

The particular difeafes to be comprehend- 
ed under this clafs, may be diftinguifhed ac- 
cording as they affect perfons in the time of 
waking or fleeping. Thofe which affect men 
awake, may again be confidered, as they con- 
fift in an erroneous judgment, to which I 
mail give the appellation of Delirium ; or as 
they confift in a weaknefs or imperfection of 
judgment, which I fhall name Fatuity. I be- 
gin with the confideration of Delirium. 

MDXXX. 



174 PRACTICE 



MDXXX. 

As men differ greatly in the foundnefs and 
force of their judgment, fo it may be proper 
here to afcertain more precifely what error or 
imperfection of our judging faculty is to be 
confidered as morbid, and to admit of the ap- 
pellations of Delirium and Fatuity. In do- 
ing this, I mail firft confider the morbid errors 
of judgment under the general appellation of 
Delirium, which has been commonly employ- 
ed to denote every mode of fuch error. 

MDXXXI. 

As our judgment is chiefly exercifed in 
difcerning and judging of the feveral relations 
of things, I apprehend that delirium may be 
defined to be, — In a perfon awake, a falfe or 
miftaken judgment of thofe relations of things, 
which, as occurring moil frequently in life, 
are thofe about which the generality of men 
form the fame judgment ; and particularly 
when the judgment is very different from 
what the perfon himfelf had before ufually 
formed. 



Ml* 



MDXXXII. 



With this miftaken judgment of relations 
there is frequently joined fome falfe percep- 
tion of external objects, without any evident 

fault 



OF PHYSIC. 175 

fault in the organs of fenfe, and which feems 
therefore to depend upon an internal caufe ; 
that is, upon the imagination arifing from a 
condition in the brain prefenting objects 
which are not actually prefent. Such falfe 
perceptions muft necelfarily occafion a de- 
lirium, or an erroneous judgment, which is 
to be confidered as the dileafe. 

MDXXXIII. 

Another circumftance, commonly attend- 
ing delirium, is a very unufual affociation of 
ideas. As, with refpecl; to moft of the affairs 
of common life, the ideas laid up in the mem- 
ory are, in moft men, aifociated in the fame 
manner ; fo a very unufual affociation, in any 
individual, muft prevent his forming the or- 
dinary judgment of thofe relations which are 
the moft common foundation of affociation in 
the memory : And therefore this unufual and 
commonly hurried affociation of ideas, ufual- 
ly is, and may be confidered as, a part of de- 
lirium. In particular it may be confidered 
as a certain mark of a general morbid affec- 
tion of the intelie&ual organs, it being an in- 
terruption or perverfion of the ordinary ope- 
rations of memory, the common and necef- 
fary foundation of the exercife of judgment. 

MDXXXIV. 

A third circumftance attending delirium, 
is an emotion or paflion, fometimes of the 

angry, 



176 PRACTICE 

angry, fometimes of the timid kind ; and 
from whatever caufe in the perception or 
judgment, it is not proportioned to fuch caufe, 
either in the manner formerly cuftomary to 
the perfon himfelf, or in the manner ufual 
with the generality of other men. 



MDXXXV. 

Delirium, then, may be more fhortly defin- 
ed, — In a perfon awake, a falfe judgment 
arifing from perceptions of imagination, or 
from falfe recolieftion, and commonly pro- 
ducing difproportionate emotions. 

Such delirium is of two kinds ; as it is com- 
bined with pyrexia and comatofe afFeftions ; 
or, as it is entirely without any fuch combi- 
nation. It is the latter cafe that we name In- 
fant ty ; and it is this kind of delirium only 
that I am to treat of here. 



MDXXXVI. 

'Infanity may perhaps be properly confid- 
ered as a genus comprehending many differ- 
ent fpecies, each of which may deferve our 
attention ; but before proceeding to the con- 
fideration of particular fpecies, I think it 
proper to attempt an inveftigation of the 
caufe of infanity in general. 

MDXXXVII. 



OF PHYSIC. 177 

MDXXXVII. 

In doing this, I fhall take it for granted, as 
demonftrated elfewhere, that although this 
difeafe feems to be chiefly, and fometimes 
folely, an affection of the mind j yet the con- 
nexion between the mind and body in this 
cafe is fuch, that thefe affections of the 
mind mult be confidered as depending 
upon a certain flate of our corporeal 
part. See Halleri Prim. Lin. Phyfiolog. 
§ dlx x. SeeBoerhaavii Inft. Med. § dlxxxi. 
dcxcvi. 

MDXXXVIII. 

Admitting this proportion, I muff in the 
next place affume another, which I likewife 
fuppofe to be demonftrated elfewhere. This 
is, that the part of our body more immediate- 
ly connected with the mind, and therefore 
more efpecially concerned in every affection 
-of the intellectual functions, is the common 
origin of the nerves ; which I fhall, in what 
follows, fpeak of under the appellation of the 
Brain. 

MDXXXIX. 

Here, however, in affuming this laft prop- 
ortion, a very great difficulty immediately 

prefents 



178 PRACTI. CE 

prefents itfelf. Although we cannot doubt 
that the operations of our intellect always de- 
pend upon certain motions taking place in 
the brain (fee Gaub. Path. Med. § 523) ; yet 
thefe motions have never been the objects of 
our fenfes, nor have we been able to perceive 
that any particular part of the brain has more 
concern in the operations of our intellect than 
any other. Neither have we attained any 
knowledge of what fhare the feveral parts 
of the brain have in that operation ; and 
therefore, in this fituation of our fcience, it 
mull be a very difficult matter to difcover 
thofe ftates of the brain that may give occa- 
fion to the various flate of our intellectual 
functions. 

dp 

MDXL. 

It may be obferved, that the different flate 
of the motion of the blood in the veffels of the 
brain has fome fhare in affecting the opera- 
tions of the intellect ; and phyficians, in feek- 
ing for the caufes of the different ftates of our 
intellectual functions, have hardly looked fur- 
ther than into the flate of the motion of the 
blood, or into the condition of the blood it- 
felf : But it is evident that the operations of 
the intellectual functions ordinarily go on, 
and are often confiderably varied, without 
our being able to perceive any difference ei- 
ther in the motions or in the condition of 
the blood. 

MDXLI. 



OF P II Y S I C. 179 

MDXLI. 

Upon the other hand, it is very probable 
that the (late of the intellectual functions de- 
pends chiefly upon the ftate and condition of 
what is termed the Nervous Power, or, as we 
fuppofe, of a fubtile very moveable fluid, in- 
cluded or inherent, in a manner we do not 
clearly underftand, in every part of the me- 
dullary fubftance of the brain and nerves, and 
which in a living and healthy man is capable 
of being moved from every one part to every 
other of the nervous fyflem. 

MDXLII. 

With refpe& to this power, we have pretty 
clear proof that it frequently has a motion 
from the fentient extremities of the nerves to*, 
wards the brain, and thereby produces fenfa- 
tion ; and we have the fame proof, that in 
confequence of volition the nervous power 
lias a motion from the brain into the mufcles 
or organs of motion. Accordingly, as fenfa- 
tion excites our intellectual operations, and 
volition is the effect of thefe, and as the con- 
nexion between fenfation and volition is al- 
ways by the intervention of the brain and of 
intellectual operations ; fo we can hardly 
doubt, that thefe latter depend upon certain 
motions, and the various modification of thefe 
motions, in the brain. 

MDXLIII, 



180 PRACTICE 



MDXLIII. 

To afcertain the different ftates of thefc 
motions may be very difficult ; and phyfi- 
cians have commonly confidered it to be fo 
very myfterious, that they have generally des- 
paired of attaining any knowledge with re- 
gard to it : But I confider fuch abfolute def- 
pair, and the negligence it infpires, to be al- 
ways very blameable ; and I Ihall now ven- 
ture to go fome length in the inquiry, hoping 
that fome fteps made with tolerable firmnefs 
may enable us to go flill further. 

MDXLIV. 

To this purpofe, I think it evident, that the 
nervous power, in the whole as well as in the 
feveral parts of the nervous fyftem, and par- 
ticularly in the brain, is at different times in 
different degrees of mobility and force. To 
thefe different ftates, I beg leave to apply the 
terms of Excitement and Collapfe. To that 
ftate in which the mobility and force are fuf- 
ficient for the exercife of the functions, or 
when thefe ftates are any way preternaturally 
increafed, I give the name of Excitement ; 
and to that ftate in which the mobility and 
force are not fufficient for the ordinary exer- 
cife of the functions, or when they are dimin- 
iihed from the ftate in which they had been 
before, I give the name of Collapfe. I beg, 

however, 



OF PHYSIC. 1S1 

however, it may be obferved, that by thefe 
terms I mean to exprefs matters of facl only » 
and without intending, by thefe terms, to ex- 
plain the circumflance or -condition, mechan- 
ical or phyfical, of the nervous power or fluid 
in thefe different ftates. 

MDvXLV, 

That thefe different ftates of excitement 
and collapfe take place on different occauons, 
muff, I think, be manifefl from numberlefs 
phenomena of the animal economy : But it is 
efpecially to our prefent purpofe to obferve, 
that the different ftates of excitement and col- 
lapfe, are in.no inftance more remarkable, 
than in the different flates of waking and 
deeping. In the latter, when quite com- 
plete, the motion and mobility of the nervous 
power, with refpecl: to the whole of what are 
called the Animal Functions, entirely ceafe, 
or, as I would exprefs it, are in a ftate of col- 
lapfe ; and are very different from the ftate of 
Waking, which in healthy perfons I would call 
a ftate of general and entire excitement,. 

MDXLVI. 

This difference in the ftates of the nervous 
£)ower in fleeping and waking being admitted, 
I muft in the next place obferve, that when 
thefe ftates are changed from the one into the 
other, as commonly happens every day, the 

Vol.. HI. I change 



i82 PRACTICE 

change is hardly ever made inflantaneoufly, 
but almofl always by degrees, and in fomc 
length of time only : And this may be ob- 
ferved with refpeft to both fenfe and motion- 
Thus when a perfon is falling afleep, the fen- 
fibility is gradually diminifhed : So that, al- 
though fomc degree of fleep has come on, 
flight impreflions will excite fenfation, and 
bring back excitement ; which the fame, or 
•even ftronger impreffions, will be infufficient 
•to produce when the flate of fleep has con- 
tinued longer, and is, as we may fay, more 
complete. In like manner, the power of vol- 
untary motion is gradually diminifhed. In 
iome members it fails fooner than in others ; 
and it is fome time before it becomes general 
and confiderable over the whole. 

The fame gradual progrefs may be remark- 
ed in a perfon's coming out of fleep : The 
ears in this cafe are often awake before the 
eyes are opened or fee clearly, and the fenfes 
are often awake before the power of voluntary 
motion is recovered ; and it is curious to ob- 
serve, that, in fome cafes, fenfations may be 
excited without producing the ordinary affo- 
.ciation of ideas. See Mem. de Berlin, 1752. 

MDXLVII. 

From all this, I think it will clearly ap- 
pear, that not only the different flates of ex- 
citement and collapfe can take place in differ- 
ent degrees, but that they can take place in 

different 



OF PHYSIC. 183 

different parts of the brain, or at lead, with 
refpect to the different functions, in different 
degrees. 

As I pre fume that almofl every perfon has 
perceived the gradual approach of fleeping 
and waking, I likewiie fuppofe every perfon 
has obferved, that, in fuch intermediate Hate 
of unequal excitement, there almofl: always 
occurs more or lefs of delirium, or dreaming, 
if any body choofes to call it fo. There are 
in this ftate falfe perceptions, falfe affociations, 
falfe judgments, and difproportionate emo- 
tions ; in fhort, all the circum fiances by which 
I have above defined delirium. 

This clearly fhows that delirium may de- 
pend, and I mall hereafter endeavour to prove 
that it commonly does depend, upon fome 
inequality in the excitement of the brain ; 
and that both thefe affertions are founded on 
this, that, in order to the proper exercife of 
our intellectual fun6tions, the excitement 
mufl be complete, and equal in every part of 
the brain. For though w6 cannot fay that 
the veftiges of ideas are laid up in different 
parts of the brain, or that they are in fome 
meafure diffufed over the whole, it will follow 
upon either fuppofition, that as our reafon- 
ing or intellectual operations always require 
the orderly and exact: recollection Or memory 
of affociated ideas ; fo, if any part of the 
brain is not excited, or not excitable, that rec- 
ollection cannot properly take place, while at 
the lame time other parts of the brain, more 
I 2 excited 



184 PRACTICE 

excited and excitable, may give falfe percep* 
tions, affociations, and judgments. 

MDXLVIII. 

It will ferve to illuftrate this, that the col- 
lapfe in fleep is more or lefs complete ; or 
that the fleep, as we commonly fpeak, is more 
or lefs profound : And therefore, that in 
many cafes, though fleep takes place to a con- 
fiderable degree, yet certain impreflions do 
ftill take effect, and excite motions, or, if you 
will, fenfations in the brain ; but which fen- 
fations, upon account of the collapfed ftate 
of fo great a part of the brain, are generally 
of the delirious kind, or dreams, confifting of 
falfe perceptions, aflbciations, and judgments, 
that would have been corrected if the brain 
had been entirely excited. 

Every one, I believe, has obferved, that the 
mod imperfect fleeps are thofe chiefly attend- 
ed with dreaming ; that dreams, therefore, 
inoft commonly occur towards morning, when 
the complete ftate of fleep is pafling away $ 
and further, that dreams are mofl commonly 
excited by ftrong and uneafy impreflions 
made upon the body. 

I apprehend it may alfo be an illuftration 
of the fame thing, that, even in waking hours, 
we have an inftance of an unequal ftate of ex- 
citement in the brain producing delirium. 
Such, I think, occurs in the cafe of fever. In 
this, it is manifeft, that the energy of trte 

brain. 



OF PHYSIC. 185 

brain, or its excitement, is confiderably di- 
minished with refpect to the animal functions : 
And it is accordingly upon this ground that 
I have explained above, in XLV, the delir- 
ium which fo commonly attends fever.. To 
what I have there faid I fhall here only add, 
that it may ferve to confirm my doctrine, that 
the delirium in fever comes on at a certain 
period of the difeafe only, and that we can 
commonly difcern its approach by a more 
than ufual degree of it appearing in the time 
of the patient's falling into or coming out <f 
fleep. It appears, therefore, that delirium, 
when it firfl comes on in fever, depends upon 
an inequality of excitement ; and it can hard- 
ly be doubted, that the delirium which comes 
at length to prevail in the entirelv weakened" 
flate of fevers, depends upon the fame caufe 
prevailing in a more confiderable degree. 

MDXLIX. 

From what has been now delivered, I hope 
it will be fufficiently evident, that delirium 
may be, and frequently is, occafioned by an 
inequality in the excitement of the brain. 

How the different portions of the brain 
may at the fame time be excited or collapfed 
in different degrees, or how the energy of the 
brain may be in different degrees of force, 
with refpecl; to the feveral animal, vital, and 
natural functions, I cannot pretend to ex- 
plain ; but it is fufficiently evident in fact, 
I 3 that 



186 PRACTICE 

that the brain may be at one and the fame 
time in different conditions with rcfpeft to 
thefe functions. Thus in inflammatory dif- 
eafes, when by a flimulus applied to the brain 
the force of the vital functions is preterriat- 
urally increafed, that of the animal is either 
little changed, or confiderably diminifhed. 
On the contrary, in many cafes of mania, the 
force of the animal functions depending al- 
ways on the brain, is prodigioufly increafed, 
while the ftate of the vital function in the 
heart is very little or not at all changed. I 
mull therefore fay again, that how difficult 
foever it may be to explain the mechanical or 
phyfical condition of the brain in fuch cafes, 
the fatts are fufficient to fhow that there is 
fuch an inequality as may diflurb our intel- 
lectual operations. 



MDL. 



I have thus endeavoured to explain the 
general caufe of Delirium ; which is of two 
kinds, according as it is with, or without, py- 
rexia. Of the firft I tal^e no further notice 
here, having explained it as well as I could 
above in XLV. 

I proceed now to confider that delirium 
which properly belongs to the clafs of Vefa- 
niae, and which I mail treat of under the gen- 
eral title of Infanity. 

MDLI. 



OF PH.YS I C. 187 

MDLI. 

In entering upon this fubjecl:, it imme- 
diately occurs, that in many inftances of 
infanity, we find, upon diffe&ion after 
death, that peculiar circumftances had tak- 
en place in the general condition of the 
brain. In many cafes, it has been found of 
a drier, harder, and firmer confiftence, than 
what it is ufually of in perfons who had not. 
been affected with that difeafe. In other 
cafes, it has been found in a more humid, 
foft, and flaccid ftate ; and in the obferva- 
tions of the late Mr. Meckel,* it has been 
found confiderably changed in its denfity or 
fpecific gravity. Whether thefe different 
ftates have been obferved to be uniformly the 
fame over the whole of the brain, I cannot 
certainly learn ; and I fufpecl: the diffe&ors 
have not always accurately inquired into this 
circumftance : But in feveral inftances, it ap- 
pears that thefe ftates had been different in 
different parts of the brain ; and inftances of 
this inequality will afford a confirmation of 
our general doctrine. 

The accurate Morgagni has obferved, that 
in maniacal perfons the medullary portion of 

the 

* Memoir, de Berlin pour l'annee 1764. It appeared 
in many inftances of infane perfons, that the medullary 
fubftance of the cerebrum was drier, and of a lefs fpecif- 
ic gravity, than in perfons who had been always of a 
found judgment. 

14 



i88 PRACTICE 

the brain is unufually dry, hard, and firm : 
And this he had fo frequently obferved, that 
he was difpofed to confider it as generally the 
cafe. But in mofl of the particular inflances 
which he has given, it appears, that, for the 
moft part, while the cerebrum was of an un- 
ufually hard and firm confidence, the cere- 
bellum was of its ufual foftnefs, and in many 
of the cafes it was unufually foft and flaccid. 
In fome other cafes, Morgagni obferves, that 
'while a part of the cerebrum was harder and 
firmer than ordinary, other parts of it were 
preternaturally foft. 

MDLII. 

Thefe obfervations tend to confirm our 
general dottrine : And there are others which 
I think will apply to the fame purpofe. 

Upon the dine&ion of the bodies of per- 
fons who had laboured under infanity, various 
organic affe&ions have been difcovered in 
particular parts of the brain ; and it is fuf- 
ficiently probable, that fuch organic affections 
might have produced a different degree of 
excitement in the free and affe&ed parts, and 
mufl have interrupted in fome meafure the 
free communication between the feveral parts 
of the brain, and in either way have occafion- 
ed infanity. 

There have occurred fo many inflances of 
this kind, that I believe phyficians are gen- 
erally difpofed to fufpecl organic lefions 

of 



OF PHYSIC. 189 

of the brain to exift in almoft every cafe of 
infanity. 

MDLIII. 

This, however, is probably a miftake : For 
we know that there have been many inftances 
of infanity from which the perfons have en- 
tirely recovered ; and it is difficult to fup- 
pofe that any organic lefions of the brain had 
in fuch cafe taken place. Such tranfitory 
cafes, indeed, render it probable, that a ftate 
of excitement, changeable by various cauf- 
es, had been the caufe of fuch inftances of 
infinity. 

MDLIV. 

It is indeed further afferted, that in many 
inftances of infane perfons, their brain had 
been examined after death, without mowing 
that any organic lefions had before fubfifted 
in the brain, or finding that any morbid ftate 
of the brain then appeared. This, no doubt, 
may ferve to ftiow, that organic lefions had 
not been the caufe of the difeafe ; but it does 
not affure us that no morbid change had tak- 
en place in the brain : For it is probable, that 
the diife&ors were not always aware of its be- 
ing the general condition of hardnefs and den- 
sity, as different in different parts of the brain, 
that was to be attended to, in order to diicov- 
cr the caufe of the preceding difeafe ; and 

Vol. 3. I § therefore 



igo PRACTICE 

therefore many of them had not with this 
view examined the Mate of the brain, as Mor-, 
gagni fecms carefully to have done. 

MDLV. 

Having thus endeavoured to inveftigate the 
caufe of infanity in general, it were to be 
wiihed that I could apply the d66hine to the 
diftinguiihing the fcveral fpecies of it, accord- 
ing as they depend upon the different ftate 
and circumftances of the brain, and thereby 
to the eftablifhing of a fcientific and accurate- 
ly adapted method of cure. Thefe purpofes, 
however, appear to me to be extremely diffi- 
cult to be attained ; and I cannot hope to 
execute them here. All I can do is to make 
fome attempts, and offer fome refle&ions, 
which further observation, and greater fagaci- 
ty, may hereafter render more ufeful. 

MDLVI. 

The ingenious Dr. Arnold has been com- 
mendably employed in diftinguiihing the dif- 
ferent fpecies of infanity as they appear with 
refpecl; to the mind ; and his labours may 
hereafter prove ufeful, when we ihall come 
to know fomething more of the different ftates 
of the brain correfponding to thefe different 
flates of the mind ; but at prefent I can make 
little application of his numerous diflin£lions. 
It appears to me that he has chiefly pointed 

out 



O.F PHYSIC. 191 

out and enumerated diftin&ions, that are 
merely varieties, which can lead to little or no 
variety of practice : And I am efpeciaUy led 
to form the latter conclufion, becaufe thefe 
varieties appear to me to be often combined 
together, and to be often changed into one 
another, in the fame perfon ; in whom we 
muff therefore fuppofe a general caufe of the 
difeafe, which, fo far as it can be known, muff, 
eflabliih the pathology, and efpecially direct 
the practice. 

MDLVII. 

In my limited views of the different ftates 
of infanity, I muft go on to confider them un- 
der the two heads of Mania and Melancholia : 
And though I am fenfible that thefe two gen- 
era do not comprehend the whole of the fpe- 
cies of infanity, I am not clear in affigning 
the other fpecies which may not be compre- 
hended under thofe titles. I mail, however, 
endeavour, on proper occafions as I go along, 
to point them out as well as I can. 



<* 



16 CHAP. 



192 PRACTICE 

C II A P. II. 
of MANIA, or MADNESS. 

MDLVIII. 

1 HE circum fiances which I 
have mentioned above in MDXXXV, as 
conftituting delirium in general, do more 
efpecially belong to that kind of it which I 
fhall treat of here under the title of Mania. 

There is fometimes a falfe perception or 
imagination of things prefent that are not ; 
but this is not a conftant, nor even a frequent, 
attendant of the difeafe. The falfe judgment* 
is of relations long before laid up in the mem- 
ory. It very often turns upon one (ingle 
fubje£t. : But more commonly the mind ram- 
bles from one fubject to another, with an 
equally falfe judgment concerning the moft 
part of them ; and as at the fame time there 
is commonly a falfe affociation, this increafes 
the confufion of ideas, and therefore the falfe 
judgments. What for the moft part more 
efpecially diftinguifhes the difeafe, is a hurry 
of mind, in purfuing any thing like a train of 
thought, and in running from one train of 

thought 



OF PHYSIC. 193 

thought to another. Maniacal perfons are 
in general very irafcible ; but what more par- 
ticularly produces their angry emotions is, 
that their falfe judgments lead to fome a&ion 
which is always pufhed with impetuofity and 
violence ; when this is interrupted or retrain- 
ed, they break out into violent anger and fu- 
rious violence againft every perfon near them, 
and upon every thing that Hands in the way 
of their impetuous will. The falfe judgment 
often turns upon a miflaken opinion of fome 
injury fuppofed to have been formerly re- 
ceived, or now fuppofed to be intended : And 
it is remarkable, that fuch an opinion is often 
with refpecl; to their former deareft friends 
and relations ; and therefore their refentment 
and anger are particularly directed towards 
thefe. And although this mould not be the 
cafe, they commonly foon lofe that refpeft 
and regard which they formerly had for their 
friends and relations. With all thefe cir- 
cumftances, it will be readily perceived, that 
the difeafe muft be attended very conflantly 
with that incoherent and abfurd fpeech we 
call raving. Further, with the circumftances 
mentioned, there is commonly joined an un- 
ufual force in all the voluntary motions ; and 
an infenfibility or refi fiance of the force of 
all impreffions, and particularly a refiftance of 
the powers cf fleep, of cold, and even of hun- 
ger ; though indeed in many inftances a vo- 
racious appetite takes place. 

MDLIX. 



194 PRACTICE 

MDLIX. 

It appears to me, that the whole of thefe 
c.ircumftances and fymptoms point out a con- 
fiderable and unulual excefs in the excite- 
ment of the brain, efpecially with refpeft to 
the animal functions ; and it appears at the 
fame time to be manifeflly in fome meafure 
unequal, as it very often takes place with ref- 
pecl; to thefe functions alone, while at the 
fame time the vital and natural are common- 
ly very little changed from their ordinary 
healthy ftate. 

MDLX. 

How this excefs of excitement is produced, 
it may be difficult to explain. In the va- 
rious inftances of what Sauvages has named 
the Mania Metajiatica> and in all the inflances 
I have mentioned in my Nofology under the 
title of the Mania Corporea> it may be fup- 
pofed that a morbid organic affection is pro- 
duced in fome part of the brain ; and how 
that may produce an increafed or unequal 
excitement in certain parts of it, I have en- 
deavoured to explain above in MDLII. But 
I muft at the fame time acknowledge, that 
fuch remote caufes of mania have very rarely 
occurred ; and that therefore fome other cauf- 
es of the difeafe muft be fought for. 

The 



OF PHYSIC. 195 

The effe&s of violent emotions or paflions 
of the mind have more frequently occurred 
as the remote caufes of mania ; and it is fuf- 
ficiently probable, that fuch violent emotions, 
as they do often immediately produce a tem- 
porary increafe of excitement, fo they may, 
upon fome occafions of their permanent in- 
herence or frequent repetition, produce a 
more confiderable and more permanent ex- 
citement, that is, a mania. 

With refpecl: to thofe caufes of mania 
which arife in confequence of a melancholia 
which had previoufly long fubfifted ; whether 
we confider that melancholia as a partial in- 
fanity, or as a long perfifting attachment to 
one train of thinking, it will be readily per- 
ceived, that in either cafe fuch an increafe of 
excitement may take place in fo confiderable 
a degree, and in fo large a portion of the 
brain, as may give occafion to a complete 
mania. 

MDLXI. 

Thefe confiderations with regard to the re- 
naote caufes appear to me to confirm fuffi- 
ciently our general doctrine of increafed and 
unequal excitement in the mania which I 
have defcribed above ; but I mufl own, that 
I have not exhaufted the fubjecl;, and that 
there are cafes of mania of which I cannot af*- 
fign the remote caufes : But although I can- 
not in all cafes explain in what manner the 

mania 



i 9 6 PRACTICE 

mania is produced, I prefume, from the ex- 
planation given, and efpecially from the 
iymptoms enumerated above, to conclude, 
that the difeafe defcribed above depends up- 
on an increafed excitement of the brain ; an 
opinion in which I am the more confirmed, 
as I think it will point out the proper method 
of cure. At leaft I think it will mod clearly 
explain the operation of thofe remedies, which, 
fo far as I can learn from my own experience 
and that of others, have proved the moft fuc- 
cefsful in this difeafe ; and, to illuflrate this, 
I now enter upon the confi deration of thefe 
remedies, and to make iome remarks upon 
the proper manner of employing them. 

MDLXII. 

Reftraining the anger and violence of mad- 
men is always neceffary for preventing their 
hurting themfelves or others : But this re- 
flraint is alfo to be confidered as a remedy. 
Angry paffions are always rendered more vi- 
olent by the indulgence of the impetuous 
motions they produce ; and even in madmen 
the feeling of reftraint will fometimes p: 
the efforts which their paflion would otherwife 
occafion. Reftraint, therefore, is nfeful, and 
ought to be complete ; but it fhould be exe- 
cuted in the eafieft manner poflible for the pa- 
tient, and the flrait waiftcoat anfwers every 
purpofe better than any other that has yet 
peen thought of. The reftraining madmen 

by 



OF PHYSIC. 197 

by the force of other men, as occafioning a 
conftant flruggle and violent agitation, is 
often hurtful. Although, on many occafions, 
it may not be fafe to allow maniacs to be up- 
on their le^s or to walk about, it is never de- 
firable to confine them to a horizontal fitua- 
tion j and whenever it can be admitted, they 
mould be more or lefs in an erecl; pofture. 
Although there may be no fymptoms of any 
preternatural fulnefs or increafed impetus of 
blood in the veffels of the brain, a horizontal 
pofture always increafes the fulnefs and ten- 
fion of thefe veffels, and may thereby increale 
the excitement of the brain. 

MDLXIII. 

The reftraint mentioned requires confine- 
ment within doors, and it mould be in a place 
which prefents as few objefts of fight and 
hearing as poffible ; and particularly, it mould 
be removed from the objects that the patient 
was formerly acquainted with, as thefe would 
more readily call up ideas and their various 
affociations. It is for this reafon that the 
confinement of madmen mould hardly ever 
be in their ufual habitation ; or if they are, 
that their apartment mould be ftripped of all 
its former furniture. It is alfo for the moft 
part proper, that maniacs mould be without 
the company of any of their former acquaint- 
ance ; the appearance of whom commonly 
excites emotions that increetfe the difeafe. 

Strangers 



*g8 PRACTICE 

Strangers may at firfl be ofFenfive ; but in a, 
little time they come to be objects either of 
indifference or of fear, and they mould not 
be frequently changed. 

MDLXIV. 

Fear being a paffion that diminifhes excite- 
ment, may therefore be oppofed to the excefs 
of it ; and particularly to the angry and iraf- 
cible excitement of maniacs. Thefe being 
more fufceptible of fear than might be ex- 
pected, it appears to me to have been com- 
monly ufeful. In mod cafes it has appeared 
to be neceffary to employ a very conftant im- 
preflion of fear ; and therefore to infpire them 
with the awe and dread of fome particular 
perfons, efpecially of thofe who are to be con- 
flantly near them. This awe and dread is 
therefore, by one means or other, to be ac- 
quired ; in the firfl place, by their being the 
authors of all the reftraints that may be occa- 
fionally proper ; but fometimes it may be 
neceffary to acquire it even by {tripes and 
blows. The former, although having the ap- 
pearance of more feverity, are much fafer 
than ftrokes or blows about the head. Nei- 
ther of them, however, mould be employed 
further than feems very neceffary, and fhould 
be trufted only to thofe whofe difcretion can 
be depended upon. There is one cafe in 
which they are fuperfluous ; that is, when the 
maniacal rage is either not fufceptible of fear, 

or 



OF PHYSIC. 199- 

or incapable of remembering the objects of 
it ; for in fuch inftances, ftripes and blows 
would be wanton barbarity. In many cafes 
of a moderate difeafe, it is of advantage that 
the perfons who are the authors of refhaint 
and punifhment mould be upon other occa, 
fions the beftowers of every indulgence and 
gratification that is admiffible ; never, however, 
neglefting to employ their awe when their 
indulgence mall have led to any abufe.. 

MDLXV. 

Although in mania, no particular irritation 
nor fulnefs of the fyftem feem to be prefent, 
it is plain, that the avoiding all irritation and 
means of fulnefs is proper ; and therefore, 
that a diet neither itimulating nor nourifhing 
is commonly to be employed. As it may 
even be ufeful to diminifh the fulnefs of the 
fyftem, fo both a low and a fpare diet is likely 
in moft cafes to be of fervice. 

MDLXVI. 

Upon the fame principle, although no un- 
ufual fulnefs of the body be prefent, it may 
be of advantage to diminifh even its ordinary 
fulnefs by different evacuations. 

Bloodletting, in particular, might be fup- 
pofed ufeful ; and in all recent cafes of ma- 
nia it has been Commonly prac~lifed, and I 
think with advantage ; but when the difeafe 

has 



2oo PRACTICE 

has fubfifted for fome time, I have feldom 
found bloodletting of fervice. In thofe in- 
ftances in which there is any frequency or 
fulnefs of pulfe, or any marks of an increafed 
impetus of the blood in the vefTels of the 
head, bloodletting is a proper and even a nec- 
effary remedy. Some practitioners, in fuch 
cafes, have preferred a particular manner of 
bloodletting, recommending arteriotomy, fcar- 
ifying the hind head, or opening the jugular 
vein ; and where any fulnefs or inflammatory 
difpofition in the velfels of the brain, is to be 
fufpe&ed, the opening of the vefTels neareft 
to them is likely to be of the greateft fervice. 
The opening, however, of either the temporal 
artery or the jugular vein in maniacal perfons 
is very often inconvenient ; and it may gen- 
erally be fufficient to open a vein in the arm, 
while the body is kept in fomewhat of an 
erecl: pofture, and fuch a quantity of blood 
drawn as nearly brings on a deliquium animi, 
which is always a pretty certain mark of fome 
diminution of the fulnefs and tenfion of the 
velfels of the brain. 

MDLXVII. 

For the fame purpofe of taking off the ful- 
nefs and tenfion of thefe vefTels of the brain, 
purging may be employed ; and I can in no 
other view underfland the celebrated ufe of 
hellebore among the ancients. I cannot, 
however, fuppofe any fpecific power in hel- 
lebore ; 



OF PHYSIC. 201 

lebore • and can by no means find that, at 
lead the black hellebore, is fo efficacious with 
us as it is faid to have been at Anticyra. As 
coflivenefs, however, is commonly a very con- 
ftant and hurtful attendant of mania, purga- 
tives come to be fometimes very neceffary ; 
and I have known fome benefit obtained from 
the frequent ufe of pretty draftic purgatives. 
In this, however, I have been frequently dif- 
appointed j and I have found more advantage 
from the frequent ufe of cooling purgatives, 
particularly the foluble tartar, than from more 
draftic medicines. 



MDLXVIII. 



Vomiting has alfo been frequently employ* 
ed in mania ; and by determining powerfully 
to the furface of the body, it may poflibly di- 
minifh the fulnefs and tenfion of the veffels, 
and thereby the excitement of the brain ; but 
I have never carried the ufe of this remedy fo 
far as might enable me to judge properly of 
its effects. Whether it may do harm by im- 
pelling the blood too forcibly into the veffels 
of the brain, or whether by its general agita- 
tion of the whole fyftem it may remove that 
inequality of excitement which prevails in 
mania, I have not had experience enough to 
^determine, 

MDLXIX, 



•02 PRACTICE 



MDLXIX. 

Frequent {having of the head has been 
found of fervice in mania, and by promoting 
perfpiration it probably takes olF from the 
excitement of the internal parts. This, how- 
ever, it is likely, may be more effe&ually done 
by bliftering, which more certainly takes. off 
the excitement of fubjacent parts. In recent 
cafes it has been found ufeful by inducing 
fleep ; and when it has that effecl;, the repe- 
tition of it may be proper : But in maniacal 
cafes that have lafled for fome time, bliftering 
has not appeared to me to be of any fervice ; 
and in fuch cafes alfo I have not found per- 
petual blifters, or any other form of iifue, 
prove ufeful. 

MDLXX. 

As heat is the principal means of firft ex- 
citing the nervous fyftem, and eftablifhing the 
nervous power and vital principle in animals ; 
"fo, in cafes of preternatural excitement, the 
application of cold might be fuppofed a prop- 
er remedy : But there are many inftances of 
maniacs who have been expofed for a great 
length of time to a confiderable degree of 
cold without having their fymptoms anywlfe 
relieved. This may render in general the 
application of cold a doubtful remedy ; but 
it is at the fame time certain, that maniacs 

have 



• OF PHYSIC. 2oj 

-have often been relieved, and fometimes en- 
tirely cured, by the ufe of cold bathing, es- 
pecially when adminiitered in a certain man- 
ner. "This feems to confift, in throwing the 
madman into the cold water by furprife ; by 
detaining him in it for Come length of time ; 
and pouring water frequently upon the head, 
while the whole of the body except the head 
is immerfed in the water ; and thus managing 
the whole procefs, fo as that, with the aflift- 
ance of fome fear, a refrigerant effect, may be 
produced. This, I can affirm, has been often 
ufeful ; and that the external application of 
cold may be of fervice, we know further, from 
the benefit which has been .received in fome 
maniacal cafes from the application of ice and 
fnow to the naked head, and from the appli- 
cation of the noted Clay Cap. 

Warm bathing alfo has been recommended 
by fome practical writers ; and in fome rigid 
melancholic habits it may poffibly be ufeful, 
or as employed in the manner prefcribed by 
fome, of immerfing the lower parts of the 
body in warm water, while cold water is pour- 
ed upon the head and upper parts. Of this 
practice, however, I have had no experience ; 
and in the common manner of employing 
warm bathing I have found it ratner hurtful 
to maniacs. 

MDLXXI. 

According to my fuppofition that the dif- 
«afe depends upon an increafed excitement of 

the 



204 PRACTICE 

the brain, efpecially with refpett to the ani* 
mal functions, opium, fo commonly powerful 
in inducing fleep, or a confiderable collapfe 
as to thefe functions, mould be a powerful 
remedy of mania. That it has truly proved 
fuch, I believe from the teftimony of Bernard 
Huet, whofe pra&ice is narrated at the end 
of Wepferi Hiftoria Apopletticorum. I 
leave to my readers to ftudy this in the work 
I have referred to, where every part of the 
practice is fully, and, as it appears to me, very 
judicioufly delivered. I have never indeed 
carried the trial fo far as feems to be requifite 
to an entire cure : But I have frequently em- 
ployed in fome maniacal cafes, large dofcs of 
opium ; and when they had the effecl; of in- 
ducing fleep, it was manifeitly with advan- 
tage. At the fame time, in fome cafes, from 
doubts, whether the difeafe might not depend 
upon fome organic lefions of the brain, when 
the opium would be fuperfluous ; and in oth- 
er cafes, from doubts, whether there might 
not be fome inflammatory afFe&ion joined 
with the mania, when the opium would be 
hurtful, I have never puihed this remedy to 
the extent that might be neceffary to make an 
entire cure. 

MDLXXII. 

Camphire has been recommended as a rem- 
edy of mania, and there are inftances alleged 
of its having performed an entire cure. As 

it 



OF PHYSIC. 205 

it appears from the experiments of Beccaria 
that this fubltance is poffefled of a fedative 
and narcotic virtue, thefe cures are not alto- 
gether improbable : But in feveral trials, and 
even in large dofes, I have found no benefit 
from it ; and excepting thofe in the Philo- 
fophical Tranfactions, N° 400, I have hard- 
ly met with any other teflimonies in its fa- 
vour, 

MDLXXIII. 

I have been informed that fome maniacs 
have been cured by being compelled- to con- 
ftant and even hard labour ; and as a forced 
attention to the conduct, of any bodily exer- 
cife, is a very certain means of diverting the 
mind from purfuing any train of thought, it 
is highly probable that fuch exercife may be 
ufeful in many cafes of mania. 

I mud conclude this fubjeft: with obferv- 
ing, that even in feveral cafes of complete ma- 
nia, I have known a cure take place in the 
courfe of a journey carried on for fome length 
of time. 

MDLXXIV. 

Thefe are the remedies which have been 
thiefly employed in the mania that has been 
above defcribed, and I believe they have been 
employed promifcuoufly without fuppofing 
that the mania was to be diftinguifhed into 

Vol. III. K different 



£ G 6 PRACTICE 

different fpecies. Indeed I afn not ready to 
lay how far it is to be fo diftinguifhed, but I 
mail offer one observation which may poffibly 
merit attention. 

It appears to me, that there are two differ- 
ent cafes of mania that are efpecially different 
according to the original temperament of the 
peribns whom the difeafe affe&s. It perhaps 
occurs moft frequently in peribns of a melan- 
cholic or atrabilarian temperament ; but it 
certainly does alfo often occur in perfons of 
that very oppofite temperament which phy- 
ficians have named the Sanguine. Accord- 
ing as the difeafe happens to occur in perfons 
of the one or other of thefe temperaments, I 
apprehend it may be confidered as of a differ- 
ent nature ; and I believe, that accurate ob- 
fervation, employed upon a fufficient number 
of cafes, would difcern fome pretty conftant 
difference, either of the fymptoms, or at leaft 
of the ftate of fymptoms, in the two cafes. I 
imagine that falfe imaginations, particular 
averfions and refentments, are more fixed and 
fteady in the melancholic than in the fan- 
<mine ; and that fomewhat inflammatory is 
more commonly joined with mania in the 
fanguine than in the melancholic. If fuch 
difference, however, does truly take place, it 
will be obvious, that it may be proper to 
make fome difference alfo in the practice. I 
am of opinion, that in the mania of fanguine 
perfons, bloodletting and other antiphlogiftic 
meafures are more proper, and have been 

more 



OF PHYSIC. 207 

more ufeful, than in the melancholic. I 
likewife apprehend that cold bathing is more 
ufeful in the fanguine than in the melanchol- 
ic : But I have not had experience enough to 
afcertain thefe points with fuflicient confi- 
dence. 

I have only to add this other obfervation, 
that maniacs of the fanguine temperament re- 
cover more frequently and more entirely than 
thofc of the melancholic. 



K 2 CHAP. 



ao8 PRACTICE 



C H A P. III. 



of MELANCHOLY, and other form* 
of INSANITY. 



MDLXXV. 

Melancholy has been 

commonly confidered as a partial infanity ; 
and as fuch it is defined in my Nofology : 
But I now entertain doubts if this be alto- 
gether proper. By a partial infanity, I un- 
derftand a falfe and miilaken judgment up- 
on one particular fubjeft, and what relates to 
it ; whilft, on every other fubjecr, the perfon 
affected judges as the generality of other men 
do. Such cafes have certainly occurred ; 
but, I believe, few in which the partial infan- 
ity is ftri&ly limited. In many cafes of gen- 
eral infanity, there is one fubjeft of anger or 
fear, upon which the falfe judgment more par- 
ticularly turns, or which is at leaft more fre- 
quently than any other the prevailing object 
of delirium : And though, from the incon- 
iiflency which this principal object of delirium 
mull produce, there is therefore alfo a great 
deal of infanity with regard to moft other ob- 
jects ; yet this lafl is in very different degrees, 
both in different perfons, and in the fame per- 

fori 



OF PHYSIC. 209 

ton at different times. Thus perfons con- 
fidered as generally infane, will, however, at 
times, and in fome cafes, pretty conftantly 
judge properly enough of prefent circum- 
ftances and incidental occurrences ; though, 
when thefe objects engaging attention are not 
prefented, the operations of imagination may 
readily bring back a general confufion, or re- 
call the particular object of the delirium. 
From thele confederations, I am inclined to 
conclude, that the limits between general and 
partial infanity cannot always be fo exactly 
afligned, as to determine when the partial af- 
fection is to be confidered as giving a peculiar 
fpecies of difeafe, different from a more gen- 
eral infanity. 

MDLXXVI. 

When infanity, neither ftri&ly partial, nor 
entirely nor conftantly general, occurs in per- 
fons of a fanguine temperament, and is at- 
tended with agreeable, rather than with angry 
or gloomy emotions, I think fuch a difeafc 
muff be confidered as different from the Ma- 
nia defcribed above ; and alfo, though par- 
tial, mull be held as different from the proper 
Melancholia to be mentioned hereafter. 

MDLXXVII. 

Such a difeafe, as different from thofe de- 
fcribed MDLIV, requires, in my opinion, a 
K 3 different 



2io PRACTICE 

different adminiflration of remedies ; and it 
will be proper for me to take particular no- 
tice of this here. 

Although it may be neceffary to reftrain 
fuch infane perfons as we have mentioned 
MDLXXVI, from purfuing the objects of 
their falfe imagination or judgment, it will 
hardly be requilite to employ the fame force 
of reftraint that is neceffary in the impetuous 
and angry mania. It will be generally luf- 
ficient to acquire fome awe over them, that 
may be employed, and fometimes even be 
neceffary, to check the rambling of their imag- 
ination, and incoherency of judgment. 

i 

MDLXXVIIL 

The reftraint juft now mentioned as necef- 
fary will generally require the patient's being 
confined to one place, for the fake of exclud- 
ing the objects, and more particularly the 
perfons, that might excite ideas connected 
with the chief objects of their delirium. At 
the fame time, however, if it can be perceiv- 
ed there are objects or perfons that can call 
off their attention from the purfuit of their 
own difordered imagination, and can fix it a 
little upon fome others, theie lafl may be fre- 
quently prefented to them : And for this rea- 
fon, a journey, both by its having the effect of 
interrupting all train of thought, and by pre- 
fenting objects engaging attention, may often 
be ufeful. In fuch cafes alfo, when the in- 

fanity 2 



OF PHYSIC. 2!i 

{anity, though more efpecially fixed upon one 
miRaken fubjeft, is not confined to this alone, 
but is further apt to ramble over other fub- 
jecls with incoherent ideas, 1 apprehend the 
confining or forcing fuch perfons to ionic 
eonftant uniform labour, may prove an u(c- 
ful remedy.. 

MDLXXIX. 

When fuch cafes as in MDLXVI occur in 
fanguine temperaments, and may therefore 
approach more nearly to Phrenitic Delirium - r 
fo, in proportion as the fymptoms of this ten- 
dency are more evident and confidcrable, 
bloodletting and purging will be the more 
proper and neceffary. 

MDLXXX. 

To this fpecies of infanity, when occurring 
in fanguine temperaments, whether it be more 
or lefs partial, I apprehend that cold bathing 
is particularly adapted ; while, in the partial 
infanity of melancholic perfons, as I mail 
Ihow hereafter, it is hardly admiflible. 

MDLXXXI. 

Having thus treated of a (pecies of infan- 
ity, difFerenr, in my apprehenllon, from both 
the Mania and Melancholia, I proceed to 
K 4 confider 



212 PRACTICE 

confider what feems more properly to belong 
to this laft. 

MDLXXXII. 

The difeafe which I name Melancholia is 
very often a partial infanity only. But as in 
many inftances, though the falfe imagination 
or judgment feems to be with refpe£l to one 
fubje£t only ; yet it feldom happens that this 
does not produce much inconfiftency in the 
other intellectual operations : And as, between 
a very general and a very partial infanity, 
there are all the poffible intermediate de- 
grees ; fo it will be often difficult, or perhaps 
improper, to diftinguifh Melancholia by the 
character of Partial Infanity alone. If I 
miftake not, it mull be chiefly diftinguifhed 
by its occurring in perfons of a melancholic 
temperament, and by its being always attend- 
ed with fome feemingly groundlefs, but very 
anxious, fear. 

MDLXXXIII. 

To explain the caufe of this, I muft ob- 
ferve, that perfon-s of a melancholic tempera- 
ment are for the moft part of a ferious thought- 
ful difpofition, and difpofed to fear and cau- 
tion, rather than to hope and temerity. Per- 
fons of this caft are lefs moveable than others 
by any impreflions ; and are therefore capa- 
ble of a clofer or more continued attention to 

one 



OF PHYSIC. 



21 



one particular object, or train of thinking. 
They are even ready to be engaged in a coa- 
ftant application to one fubjecl j and are re- 
markably tenacious of whatever emotions 
they happen to be affe61:ed with. 

MDLXXXIV. 

Thefe circumflances of the melancholic 
character, feem clearly to ihow, that perfons 
firongly afFe&ed with it may be readily feiz- 
ed with an anxious fear ; and that this, when 
much indulged, as is natural to fuch perfons, 
may eafily grow into a partial infanity. 

MDLXXXV. 

Fear and dejection of mind, or a timid and 
defponding difpofition, may arife in certain 
ftates, or upon certain occafions, of mere de- 
bility : And it is upon this footing, that I fup- 
pofe it fometimes to attend dyfpepfia. But 
in thefe cafes, I believe the defpondent dif- 
pofition hardly ever arifes to a confiderable 
degree, or proves fo obftinately fixed as when 
it occurs in perfons of a melancholic tem- 
perament. In thefe laft, although the fear 
proceeds from the fame dyfpeptic feelings as in 
the other cafe, yet it will be obvious, that the 
emotion may rife to a more confiderable de- 
gree ; that it may be more anxious, more fix- 
ed, and more attentive ; and therefore may 
exhibit all the various cncumitances which I 

Vol. 3. K 5 have 



214 PRACTICE 

have mentioned in MCCXXII to take place 
in the difeafe named Hypochondriasis. 

MDLXXXVI. 

In confidering this fubjecl: formerly in dif- 
tinguifhing Dyfpepfia from Hypochondriafis, 
although the fymptoms affe&ing the body be 
very much the fame in both, and even thole af- 
fecting the mind be fomewhat fimilar, I found 
no difficulty in diftinguiihing the latter difeafe, 
merely from its occurring in perfons of a mel- 
ancholic temperament. But I mud now ac- 
knowledge, that I am at a lofs to determine 
how in all cafes hypochondriafis and melan- 
cholia maybe diftinguifhed from one another, 
whilfl the fame temperament is common to 
both. 

MDLXXXVII. 

I apprehend, however, that the diftin&ion 
may be generally afcertained in the following 
manner. 

The hypochondriafis I would confider as 
being always attended with dyfpeptic fymp- 
toms : And though there may be, at the fame 
time, an anxious melancholic fear arifing from 
the feeling of thefe fymptoms ; yet while this 
fear is only a miflaken judgment with refpecr. 
to the ftate of trie perfon's own health, and to 
the danger to be from thence apprehended, I 
would flill confider the difeafe as a hypochon- 
driafis, 



(DP PHYSIC. 

driafis, and as diflincr. from the proper melan- 
cholia. But when an anxious fear and def- 
pondency arifes from a miitaken judgment 
with refpect to other circumftances than thole 
of health, and more efpecially when the pcr- 
lbn is at the fame time without any dyfpep- 
tic fymptoms, every one will readily allow 
this to be a difeafe widely different from botl. 
dyfpepfia and hypochondriacs ; and it is; . 
what I would ftncxly name Melancholia. 



MDLXXXVIII.. 



In this there feems little difficulty : But as 
an exquifitely melancholic temperament may 
induce a torpor and flownefs in the action of 
the ftomach, fo it generally produces fome 
dyfpeptic fymptoms ; and from thence there 
may be fome difficulty in diftinguifhing fuch 
a cafe from hypochondriacs. But I would 
maintain, however, that when the characters 
of the temperament are ftrongly marked ; and 
more particularly when the falfe imagination 
tarns upon other fubje&s than that of health, 
or when, though relative to the perfon's own 
body, it is of a groundlcfs and abfurd kind ; 
then, notwifchftanding the appearance of fome 
dyfpeptic fymptoms, the cafe is flill to be 
confidered as that of a melancholia, rather 
than a hypoehondriafis. 

K6 MDLXXXIX. 



2iG PRACTICE 



MDLXXXIX. 

The difeafc of melancholia, therefore, man- 
ifeftly depends upon the general temperament 
of the body : And although, in many per tons, 
this temperament is not attended with any 
morbid affection either of mind or body ; yet 
when it becomes exquifitely formed, and is 
in a high degree, it may become a difeafe af- 
fecting both, and particularly the mind. It 
will therefore be proper to confider in what 
this melancholic temperament efpecially con- 
fids ; and to this purpofe, it may be obferv- 
ed, that in it there is a degree of torpor in the 
motion of the nervous power, both with ref- 
pect to fenfation and volition ; that there is a 
general rigidity of the fimple folids ; and that 
the balance of the fanguiferous fyfliem is up- 
on the fide of the veins. But all thefe cir- 
cumftances are the directly oppofite of thofe 
of the fanguine temperament ; and mull 
therefore alfo produce an oppofite flate of 
mind. 

MDXC. 

It is this flate of the mind, and the flate of 
the brain correfponding to it, that is the chief 
object of our prefent consideration. But 
■what that Mate of the brain is, will be fuppof- 
ed to be difficult to explain ; and it may per- 
haps feem ram in me to attempt it, 

I will- 



OF PHYSIC. 217 

I will, however, venture to fay, that it is 
probable the melancholic temperament of 
mind depends upon a drier and firmer tex- 
ture in the medullary fubftance of the brain ; 
and that this perhaps proceeds from a certain 
want of fluid in that fubftance, which appears 
from its being of a leffer fpecific gravity than 
ufual. That this ftate of the brain in melan- 
cholia does actually exift, I conclude, J?r/?, 
from the general rigidity of the whole habit ; 
and, fecondly, from diffeclions, mowing fuch 
a ftate of the brain to have taken place in ma- 
nia, which is often no other than a higher de- 
gree of melancholia. It does not appear to 
me anywife difficult to i'uppofe, that the fame 
flate of the brain may in a moderate degree 
give melancholia ; and in a higher, that ma- 
nia which melancholia fo often paffes into ; 
efpecially if I fliall be allowed further to fup- 
pofe, that either a greater degree of firmnefs 
in the fubftance of the brain may render it 
fufceptible of a higher degree of excitement, 
or that one portion of the brain may be liable 
to acquire a greater firmnefs than others, and 
confequently give occafion to that inequality 
of excitement upon which mania fo much de- 
pends. 

MDXCI. 

I have thus endeavoured to deliver what 
appears to me moft probable with refpecl; to 
the proximate caufe of melancholia ; and al- 
though 



2i8 PRACTICE 

though the matter mould in fome refpe&s re- 
main doubtful, I am well perfuaded that thefe 
obfervations may often be employed to direcl 
our practice in this difeafe, as I mail now en- 
deavour to (how. 

MDXCII. 

In mofl of the inftances of melancholia, the 
mind is to be managed very much in the fame 
manner as I have advifed above with regard 
to hypochondriafis ; but as in the cafe of 
proper melancholia, there is commonly a falfe 
imagination or judgment appearing as a par- 
tial infanity, it may be further neceiiary in 
fuch cafes to employ fome artifices for cor^. 
reeling fuch imagination or judgment. 

MDXCIII. 

The various remedies for relieving the dyf- 
peptic fymptoms which always attend hypo- 
chondriafis, will feldom be either requifite or 
proper in melancholia. 

There is only one of the dyfpeptic fymp- 
toms, which, though there ihould be no oth- 
er, is very conflantly prefent in melancholia, 
and that is colli venefs. This it is always 
proper and even neceffary to remove ; and I 
believe it is upon this account that the ufe of 
purgatives has been found fo often ufeful in 
melancholia. Whether there be any purga- 
tives peculiarly proper in this cafe, I dare not 
pofitively determine j but with refpect. to the 

choice , 



OF PHYSIC. 219 

choice of purgatives in melancholia, I am of 
the fame opinion that I delivered above on 
this fame fubjecl; with refpecl to mania. 

MDXCIV. 

With refpecl; to other remedies, I judge 
that bloodletting will more feldom be proper 
in melancholia than in mania ; but how far 
it may be in any cafe proper, muft be deter- 
mined by the fame confiderations as in the 
cafe of mania. ♦ 

MDXCV. 

The cold bathing that I judged to be lb 
very ufeful in feveral cafes of infanity, is, I 
believe, in melancholia, hardly ever fit to be 
admitted ; at leaft while this is purely a par- 
tial affection, and without any marks of vio- 
lent excitement. On the contrary, upon ac- 
count of the general rigidity prevailing in mel- 
ancholia, it is probable that warm bathing 
may be often ufeful. 

MDXCVI. 

With refpecl to opiates which I have fup- 
pofed might often be ufeful in cafes of mania, 
I believe they can feldom be properly em- 
ployed in the partial infanities of the melan- 
cholic, except in certain inftances of violent 
excitement, when the melancholia approach- 
es nearly to the ftate of mania. 

MDXCVII. 



22o P R A C T I C E, &c. 

MDXCVII. 

In fuch cafes of melancholia approaching 
to a ftate of mania, a low diet may iometimes 
be neceflary ; but as the employing a low diet 
almoll unavoidably leads to the ule of vege- 
table food, and as this in every torpid Mate of 
the ftomach is ready to produce fome dyfpep- 
tic fymptoms, fuch vegetable food ought, in 
moderate cafes of melancholia,, to be ufed 
with fome caution. 

Though exercife, as a tonic power, is not 
proper either in hypochondriacs or melan- 
cholia ; yet, with refpecl to its effects upon 
the mind, it may be extremely ufeful in both, 
and in melancholia is to be employed in the 
fame manner that I have advifed above in the 
cafe of hypochondria fis. 

MDXCVII I. 

Having now delivered my doctrine with 
refpecl: to the chief forms of infanity, I mould 
in the next place proceed to confider the 
other genera of Amentia and Oneirodynia, 
which in the Nofology I have arranged un- 
der the order of Vefanias : But as I cannot 
pretend to throw much light upon thefe 
iubjects, and as they are fddom the objects 
of practice, I think it allowable for me to pafs 
them over at prefent ; and the particular cir- 
cumflances of this work in fome meafure re- 
quires that I fljould do fo. 

PART 




Of Q?acA 



acnecciej. 



MDXCIX. 



ry py 
ftate. 



NDER this title I propofe to 
eftablifh a clafs of difeafes, 
which confift in a depraved 
ftate of the whole, or of a con- 
fiderable part, of the habit of 
the body, without any prima- 
a. or neurons combined with that 

MDC. 




The term Cachexy has been employed by 
Linnaeus and Vogel, as it had been formerly 
by other authors, for the name of a particular 
difeafe : But the difeafe to which thefe au- 
thors 



222 PRACTICE, Sec 

thors have affixed it, comes more properly 
under another appellation ; and the term of 
Cachexy is more properly employed by Sal- 
vages and Sagar lor the name of a clafs. In 
this I have followed the laft mentioned no- 
fologiils, though I find it difficult to give 
fuch a character of the clafs as will clearly 
apply to all the fpecics I have comprehended 
under it. This difficulty would be flill great- 
er, if, in the clafs I have eftablifhed under 
the title of Cachexies, I were to comprehend 
all the difeafes that thofe other nofologifts 
have done ; but I am willing to be thought 
deficient rather than very incorrect. Thofe 
difficulties, however, which ftill remain in 
methodical nofology, mull not affect us much 
in a treatife of practice. If I can here prop- 
erly diftinguiih and defcribe the feveral fpe- 
cies that truly and moll commonly exift, I 
(hall be the lefs concerned about the accuracy 
of my general claflification : Though at the 
fame time this, I think, is always to be at- 
tempted j and I mall purfue it as well as 1 
can. 



O O KL 



223 




BOOK 



I. 



©f EMACIATIONS 



MDCI. 

Emaciation, or a con- 

fiderable diminution of the bulk or plump- 
nefs of the whole body, is for the moll; part 
only a fymptom of difeafe, and very feidom 
to be confidered as a primary and idiopathic 
aflFedlion. Upon this account, according to 
my general plan, fuch a fymptom might per- 
haps have been omitted in the Methodical 
Nofology : But both the uncertainty of con- 
cluding it to be always fymptomatic, and the 
confiftency of fy Item, made me introduce in- 
to the Nofology, as others had done, an order 
under the title of Marcorcs ; and this renders 
it requisite now to take fome notice of fuch 
difeafes. 

MDCII. 



224 PRACTICE 



MDCII. 

Upon this occafion, therefore, I hope it 
may be ufeful to inveftigate the Itveral caufes. 
of emaciation in all the different cafes of dif- 
eafe in which it appears. And this I attempt, 
as the fureft means of determining how far it 
is a primary, or a fymptomatic affection only j 
and even in the latter view, the inve {ligation, 
may be attended with fome advantage. 

MDCIII. 

The caufes of emaciation may, I appre- 
hend, be referred to two general heads ; that 
is, either to a general deficiency of fluid in 
the vefTels of the body, or to the particular 
deficiency of the oil in the cellular texture of 
it. Thefe caufes are frequently combined 
together ; but it will be proper, in the firfl 
place, to confider them feparately. 

MDCIV. 

As a great part of the body of animals is 
made up of vefTels filled with fluids, the bulk 
of the whole muft depend very much on the 
fize of thefe vefTels, and the quantity of fluids 
prefent in them : And it will therefore be 
fufnciently obvious, that a deficiency of the 
fluids in thefe vefTels muft, according to its 
degree, occafion a proportionate diminution 

of 



OF PHYSIC. 225 

of the bulk of the whole body. This, how- 
ever, will appear flill more clearly, from con- 
iidering that in the living and found body the 
veffels every where feem to be preternaturally 
diftended by the quantity of fluids prefent 
in them ; but being at the fame time elaftic, 
and conftantly endeavouring to contract: 
themfelves, they muft, on the withdrawing of 
the di (lending force, or, in other words, upon 
a diminution of the quantity of fluids, be in 
proportion contracted and diminifhed in their 
fize : And it may be further obferved, that 
as each part of the vafcular fyftem communi- 
cates with every other part of it ; fo every de- 
gree of diminution of the quantity of fluid, in 
any one part, muft in proportion diminifh 
the bulk of the vafcular fyftem, and confe- 
quently of the whole body. 

MDCV. 

The diminution and deficiency of the fluids 
may be occafioned by different caufes : Such 
as, firft, by a due quantity of aliments not be- 
ing taken in ; or by the aliment taken in, not 
being of a fufficiently nutritious quality. Of 
the want of a due quantity of aliment not be- 
ing taken into the body, there is an inftance 
in the Atrophia lattantium Sauvagefii, fpecies 
3 ; and many other examples have occurred of 
emaciation from want of food, occafioned by 
poverty, and other accidental caufes. 

With 



£26 PRACTICE 

With refpedl to the quality of food, I ap- 
prehend it arifes from the want of nutritious 
matter in the food employed, that perfons liv- 
ing very entirely on vegetables are feldom of 
a plump and fucculent habit. 

MDCVI. 

A fecond caufe of the deficiency of fluids 
may be, the aliments taken in not being con- 
veyed to the bloodveffels. This may occur 
from a perfon's being affected with a frequent 
vomiting ; which, rejecting the food foon after 
it had been taken in, muft prevent the necef- 
fary fupply of fluids to the bloodveffels. 

Another caufe, frequently interrupting the 
conveyance of the alimentary matter into the 
bloodveffels, is an obftru&ion of the conglo- 
bate or lymphatic glands of the mefentery, 
through which the chyle muft neceflarily pafs 
to the thoracic duel. Many in (lances of ema- 
ciation, feemingly depending upon this caufe, 
have been obfei ved by phyficians, in perfons 
of all ages, but efpecially in the young. It 
has alfo been remarked, that fuch cafes have 
mofl frequently occurred in fcrophulous per- 
fons, in whom the mesenteric glands are com- 
monly affected with tumour or obflruction, 
and in whom, generally at the fame time, 
fcrophula appears externally. Hence the 
Tabes Jcrophulofa Synop. Nofolog. vol. ii. p» 
266 : And under thefe I have put as fynon- 
imes Tabes glandularis, fp. 10 ; Tabes mejen- 

terica^ 



OF PHYSIC. 227 

/ erica, fp. 9 ; Scrophula mefenterica, fp. 4 ; 
Atrophia infantilis, fp. 13; Atrophia rachit- 
ic^ fp. 8 ; Tabes rachialgica, fp. 16. At the 
lame time, I have frequently found the cafe 
occurring in perfons who did not lhow any 
external appearance of fcrophula, but in 
whom the mefenteric obftruftion was after- 
wards discovered by diffe&ion. Such alfo I 
iuppofe to have been the cafe in the difeafe 
frequently mentioned by authors under the 
title of the Atrophia infantum. This has re- 
ceived its name from the time of life at which 
it generally appears ; but I have met with in- 
flances of it at fourteen years of age ascer- 
tained by diffection. Jn feveral fuch cafes 
which I have feen, the patients were without 
any fcrophulous appearances at the time, or 
it any period of their lives before. 

In the cafe of phthifical perfons, I fhall 
hereafter mention another caufe of their ema- 
ciation ,• but it is probable that an obflruction 
of the mefenteric glands, which lb frequently 
happens in fuch perfons, concurs very power- 
fully in producing the emaciation that takes 
place. 

Although a fcrophulous taint may be the 
mofl frequent caufe of mefenteric obftruc- 
tions, it is fufficiently probable that other 
kinds of acrimony may produce the fame, and 
the emaciation that follows. 

It may perhaps be fuppofed, that the in- 
terruption of the chyle's paffing into the 
bloodveflels may be fometimes owing to a 

fault 



228 PRACTICE 

fault of the abforbents on the internal furface 
of the inteflines. This, however, cannot be 
readily afcertained : But the interruption of 
the chyle's palling into the bloodvefiels may 
certainly be owing to a rupture of the tho- 
racic du£t ; which, when it does not prove 
foon fatal, by occafioning a hydrothorax, 
muft in a fhort time produce a general ema- 
ciation. 



MDCVII. 



A third caufe of the deficiency of the fluids 
may be a fault in the organs of digeftion, as 
not duly converting the aliment into a chyle 
fit to form in the bloodveffels a proper nu- 
tritious matter. It is not, however, eafy to 
afcertain the cafes of emaciation which are to 
be attributed to this caufe ; but I apprehend 
that the emaciation which attends long fub- 
fifling cafes of dyfpepfia, or of hypochondri- 
afis, is to be explained chiefly in this way. 
It is this which I have placed in the Nofol- 
ogy under the title of the Atrophia debilium; 
and of which the Atrophia nervofa, Sauv. fp. 
1, is a proper inftance, and therefore put there 
as a fynonime. But the other titles of Atro- 
phia lateralis^ Sauv. fp. 15, and Atrophia fen* 
iliSy Sauv. fp. ii, are not fo properly put 
there, as they mull be explained in a differ- 
ent manner* 

MDCVUU 



OF PHYSIC. 229 



MDCVIII. 

A fourth caufe of a deficiency of the fluids 
in the body, may be exceflive evacuations 
made from it by different outlets ; and Sau- 
vages has properly enumerated the following 
lpecies, which we have put as fynonimes un- 
der the title of Atrophia inanitorum ; as, 
Tabes nutricum t fp. 4, Atrophia nutricum, fp. 
5, Atrophia d leucorrhoza> l'p. 4, Atrophia ab 
alvijluxuy fp. 6, Atrophia d ptyalifmo i fp. 7, 
and laftly, the Tabes a Janguijluxu ; which, 
it is to be obferved, may arife not only 
from fpontaneous hemorrhagies or accidental 
wounds, but alfo from bloodletting in too 
large a quantity, and too frequently re- 
peated. 

Upon this fubjecl: it Items proper to ob- 
ferve, that a meagre habit of body frequently 
depends upon a full perfpiration being con- 
flantly kept up, though at the fame time a 
large quantity of nutritious aliment is regu- 
larly taken in. 

MDCIX. 

Befides this deficiency of fluids from evac- 
uations by which they are carried entirely out 
of the body, there may be a deficiency of fluid 
and emaciation in a confiderable part of the 
body, by the fluids being drawn into one part, 
or collected into one cavity ; and of this we 

Vol. III. L have 



230 PRACTICE 

have an inftance in the Tabes a hydrope, Sauv. 
f P- 5- 

MDCX. 

In the Methodical Nofology, among the 
■other fynonimes of the Atrophia inanitorum I 
have fet down the Tabes dorfalis ; but wheth- 
er properly or not, I at prefent very much 
doubt. In the evacuation confidered as the 
caufe of this tabes, as the quantity evacuat- 
ed is never fo great as to account for a gen- 
eral deficiency of fluids in the body, we rauft 
feek for another explanation of it. And 
whether the effects of the evacuation may be 
accounted for, either from the quality of the 
fluid evacuated, or from the fingularly ener- 
vating pleafure attending the evacuation, or 
from the evacuation's taking off the tenfion 
of parts, the tenfion of which has a fingular 
power in fupporting the tenfion and vigour 
of the whole body, I cannot pofitively deter- 
mine ; but I apprehend that upon one or 
other of thefe fuppofitions the emaciation at- 
tending the tabes dorfalis mull be accounted 
for; and therefore that it is to be confidered 
as an inftance of the Atrophia debilium, rather 
than of the Atrophia inanitorum. 

MDCXI. 

A fifth caufe of a deficiency of fluids and 
of emaciations in the whole or in a particular 

part 



OF PHYSIC. 



231 



part of the body, may be the concretion of the 
frnall veffels, either not admitting of fluids, or 
of the fame proportion as before ; and this 
feems to me to be the cafe in tne Atrophia 
fenilis, Sauv. fp. 2. Or it may be a pally of 
the larger trunks of the arteries rendering 
them unfit to propel the blood into the fmall- 
er velfels ; as is frequently the cafe of para- 
lytic limbs, in which the arteries are affected 
as well as the mufcles. The Atrophia late- 
ralis, Sauv. fp. 15, feems to be of this nature. 

MDCXII. 

A fecond general head of the caufes of 
emaciation I have mentioned in MDCII to 
be a deficiency of oil. The extent and quan- 
tity of the cellular texture in every part of 
the body, and therefore how considerable a 
part it makes in the bulk of the whole is now 
well known. But this fubftance, in different 
circumflances, is more or lefs filled with an oily 
matter ; and therefore the bulk of it, and in 
a great meafure that of the whole body, muft 
be greater or lefs according as this fubftance 
is more or lefs filled in that manner. The 
deficiency of fluids, for a reafon to be imme- 
diately explained, is generally accompanied 
with a deficiency of oil : But phyficians have 
commonly attended more to the latter caufe 
of emaciation than to the other, that being 
ufually the moll: evident ; and I fhall now en- 
deavour to aflign the feveral caufes of the 
L 2 deficiency 



23 2 PRACTICE 

deficiency of oil as it occurs upon different 
occafions. 

MDCXIIL 

The bufmefs of fecretion in the human 
body is in general little underftood, and in no 
inftance lefs fo than in that of the fecretion 
of oil from blood which does not appear pre- 
vioufly to have contained it. It is poflible, 
therefore, that our theory of the deficiency of 
oil may be in feveral refpetts imperfect ; but 
there are certain facts that may in the mean 
time apply to the prefent purpofe. 

MDCXIV. 

Firft, it is probable, that a deficiency of oil 
may be owing to a ftate of the blood in ani- 
mal bodies lets fitted to afford a fecretion of 
oil, and consequently to fupply the wafte of it 
that is conftantly made. This ftate of the 
blood muft efpecially depend upon the ftate 
of the aliments taken in, as containing lefs of 
oil or oily matter. From many observations 
made, both with refpect to the human body 
and to that of other animals, it appears pretty 
clearly, that the aliments taken in by men and 
domeftic animals, according as they contain 
more of oil, are in general more nutritious, 
and in particular are better fitted to fill the 
cellular texture of their bodies with oil. I 
might illuftrate this, by a minute and partic- 
ular 



OF PHYSIC. 



2 33 



ular confideration of the difference of ali- 
mentary matters employed ; but it will be 
enough to give two inftances. The one is, 
that the herbaceous part of vegetables, does' 
not fatten animals, fo much "as the feeds of 
vegetables, which manifeftly contain in any 
given weight a greater proportion of oil ; and 
a fccond inftance is, that in general vegetable 
aliments do not fatten men fo much as animal 
food, which generally contains a larger pro- 
portion of oil. 

It will be obvious, that upon the fame 
principles a want of food, or a lefs nutritious 
food, may not only occafion a general defi- 
ciency of fluids (MDCIV), but muft alfo af- 
ford lefs oil, to be poured into the cellular 
texture.. In fuch cafes, therefore, the ema- 
ciation produced, is to be attributed to both, 
thefe general cauies... 

MDCXV. 

A fecond cafe of the deficiency of oil may^ 
be explained in this manner. It is prettv 
manifeft, that the oil of the blood is fecreted 
and depofited in the cellular texture in great- 
er or lelfer quantity, according as the circula- 
tion of the blood is fafler or flower ; and 
therefore that exercife, which haftens the cir- 
culation of the blood, is a frequent caufe of 
emaciation. Exercife produces this effect in 
two ways, lft, By increafmg the perfora- 
tion, and thereby carrying off a greater quan- 
L 3 tity 



234 PRACTICE 

tity of the nutritious matter, it leaves lefs of 
it to be depofited in the cellular texture ; 
thereby not only preventing an accumulation 
of fluids, but, as I have faid above, caufing a 
general deficiency of thefe, which muft alio 
caufe a deficiency of oil in the cellular tex- 
ture. 2dly, It is well known, that the oil de- 
pofited in the cellular texture is upon many 
occafions, and for various purpoles of the 
economy, again abforbed, and mixed or dif- 
fufed in the mafs of blood, to be from thence 
perhaps carried entirely out of the body by 
the feveral excretions. Now, among other 
purpofes of the accumulation and reabforp- 
tion of oil, this feems to be one, that the oil is 
requifite to the proper attion of the moving 
fibres in every part of the body ; and there^ 
fore that nature has provided for an absorp- 
tion of oil to be made according as the a&ion 
of the moving fibres may demand it. It will 
thus be obvious, that the exercife of the muf- 
cular and moving fibres every where, muft 
occafion an abforption of oil ; and conse- 
quently that fuch exercife not only prevents 
the fecretion of oil, as has been already faid, 
but may alfo caufe a deficiency of it, by oc- 
cafioning an abforption of what had been 
depofited ; and in this way, perhaps efpecial- 
]y, does it produce emaciation. 

MDCXVI. 

A third cafe of the deficiency of oil may 
occur from the following caufe. It is prob- 

able 3 



OF PHYSIC. 235 

able, that one purpofe of the accumulation of 
oil in the cellular texture of animals is, that 
it may, upon occafion, be again abforbed 
from thence, and carried into the mafs of 
blood, for the purpofe of enveloping and cor- 
recting any unufual acrimony arifing and ex- 
ifting in the ftate of the fluids. Thus, in 
mod inftances in which we can difcern an 
acrid ftate of the fluids, as in fcurvy, cancer, 
fyphilis, poifons, and feveral other difeafes, 
we find at the fame time a deficiency of oil 
and an emaciation take place ; which, in my 
apprehenfion, mull be attributed to the ab- 
forption of oil y which the prefence of acrimo- 
ny in the body excites. 

It is not unlikely that certain poifons intro- 
duced into the body, may fubfift there ; and, 
giving occafion to an abforption of oil, may 
lay a foundation for the Tabes d veneno, Sauv. 
fp. 17. 

MDCXVII. 

A fourth cafe of emaciation, and which I 
would attribute to a fudden and confidcrable 
abforption of oil from the cellular texture, is 
that of fever, which fo generally produces 
emaciation. This may perhaps be in part 
attributed to the increafed perfpi ration, and 
therefore to the general deficiency of fluids 
that may be fuppofed to take place : But 
whatever {hare that may have in producing 
the effect, we can, from the evident fhrinking 
L 4 and 



236 PRACTICE 

and diminution of the cellular fubftance, 
wherever it falls under our obfervation, cer- 
tainly conclude, that there has been a very 
confiderable abforption of the oil which had 
been before depofited in that fubftance. This 
explanation is rendered the more probable 
from this, that I fuppofe the abforption 
mentioned is neceffarily made for the purpofe 
of enveloping or correcting an acrimony, 
which manifeftly does in many, and may be 
fufpected to arife in all, cafes of fever. The 
moil remarkable inftance of emaciation oc- 
curring in fevers, is that which appears in the 
cafe of hectic fevers. Here the emaciation 
may be attributed to the profufe fweatings 
that commonly attend the difeafe : But there 
is much reafon to believe, that an acrimony 
alio is prefent in the blood ; which, even in 
the beginning of the difeafe, prevents the fe- 
cretion and accumulation of oil ; and in the 
more advanced ftates of it, mull occafion a 
more, confiderable abforption of it ; which, 
from the fhrinking of the cellular fubftance, 
feems to go farther than in almoft any other 
inftance. 

Upon the fubjecl; of emaciations from a de- 
ficiency of fluids, it may be obferved, that 
every increafed evacuation excites an abforp- 
tion from other parts, and particularly from 
the cellular texture ; and it is therefore prob- 
able, that a deficiency of fluids, from increaf- 
ed evacuations, produces an emaciation, not 
only by the wafte of the fluids in the valvu- 
lar 



O ) PHYSIC. 



237 



lar fyftem, but alfo by occasioning a confider- 
able abforDtion from the cellular texture. 



MDCXVIII. 

I have thus endeavoured to explain the 
feveral cafes and caufes of emaciation ; but I 
could not profecute the consideration of thefe 
here in the order thev are fet down in the 
Methodical Nofology. In that work I was 
engaged chiefly in arranging the Species of 
Sauvages ; but it is my opinion now, that the 
arrangement there given is erroneous, in both 
combining and feparating fpecies improper- 
ly : And it feems to me more proper here to 
take notice of difeafes, and put them together, 
according to the affinity of their nature, rath- 
er than by that of their external appearances. 
I doubt, if even the diftinclion of the Tabes 
and Atrophia, attempted in the Nofology, 
will properly apply ; as I think there are 
certain difeafes of the fame nature, which 
fometimes appear with, and fometimes with- 
out, fever. 

MDCXIX. 

After having confidered the various cafes 
of emaciations, I fhould perhaps treat of their 
cure : But it will readily appear, that the 
greater part of the cafes above mentioned are 

Vol. 3. L 5 purely 



238 PRACTICE, Sec. 

purely Symptomatic, and confequently that 
the cure of them muft be that of the primary 
difeafes upon which they depend. Of thofe 
cafes that can anywife be confidered as idio- 
pathic, it will appear that they are to be cur- 
ed, entirely by removing the remote caufes ; 
the means of accomplishing which mult be 
fufficiently obvious. 






BOOK 



2 39 




BOOK II. 



of INTUMESCENTI.E, or GENER- 
AL SWELLINGS. 

MDCXX. 



1 HE fwell'ings to be treated 
of in this place, are thofe which extend over 
the whole or a great part of the body ; or 
fuch at leaft, as, though of fmall extent, are 
however of the fame nature with thofe that 
are more generally extended. 

The fwellings comprehended under this ar- 
tificial order, are hardly to be diftinguifhed 
from one another otherwife than by the mat- 
ter they contain or confift of : And in this 
view I have divided the order into four fec- 
tions, as the fwelling happens to contain, 1/?, 
L6 Oil; 



2 4 o PRACTICE 

Oil ; 2d, Air ; 3d, A watery fluid ; or, 4^ 
As the increafed bulk depends upon the en- 
largement of the whole fubftance of certain 
parts, and particularly of one or more of the 
abdominal vifcera. 






CHAP. 



OF PHYSIC. 241 

CHAP. L 
of ADIPOSE SWELLINGS. 

MDCXXI. 

jL HE only difeafe to be men- 
tioned in this chapter, I have, with other No- 
fologifts, named Polyfarcia ; and in Englifh 
it may be named Corpulency, or, more ftricl- 
]y, Obefity ; as it is placed here upon the 
common fuppofition of its depending chiefly 
upon the increafe of oil in the cellular texture 
of the body. This corpulency, or obefity, is 
in very different degrees in different perfons, 
and is often confiderable without being con- 
fidered as a difeafe. There is, however, a 
certain degree of it, which will be generally 
allowed to be a difeafe ; as, for example, 
when it renders perfons, from a difficult ref- 
piration, uneafy in themfelves, and, from the 
inability of exercife, unfit for difcharging the 
duties of life to others : And for that reafon I 
have given fuch a difeafe a place here. Many 
phyficians have confidered it as an object of 
practice, and as giving, even in no very high 
degree, a difpofition to many difeafes ; I am 
of opinion that it mould be an object of prac- 
tice 



242 PRACTICE 

tice more frequently than it has been, and 
therefore that it merits our confideration 
here. 

MDCXXII. 

It may perhaps be alleged, that I have not 
been fufficiently correft, in putting the difeafe 
of corpulency as an intumefcentia pinguedi- 
nofa, and therefore implying its being an in- 
creafe of the bulk of the body from an accu- 
mulation of oil in the cellular texture only. 
I am aware of this objection : And as I have 
already faid, that emaciation (MDCII) de- 
pends either upon a general deficiency of flu- 
ids in the vafcular fyftem, or upon a deficien- 
cy of oil in the cellular texture ; fo I mould 
perhaps have obferved farther, that the cor- 
pulency, or general fulnefs of the body, may 
depend upon the fulnefs of the vafcular fyf- 
tem as well as upon that of the cellular tex- 
ture. This is true ; and for the fame reafons 
I ought, perhaps, after Linnaeus and Sagar, 
to have fet down plethora as a particular dif- 
eafe, and as an inilance of morbid intumef- 
cence. I have, however, avoided this, as Sau- 
vages and Vogel have done ; becaufe I ap- 
prehend that plethora is to be confidered as a 
ftate of temperament only, which may indeed 
difpofe to difeafe ; but not as a difeafe in it- 
felf, unlefs, in the language of the Stahlians, 
it be a plethora commota, when it produces a 
difeafe accompanied with particular fymp- 

tomsj 



OF PHYSIC. 243 

toms, which give occafion to its being diftin- 
guifhed by a different appellation. Further, 
it appears to me, that the fymptoms which 
Linnseus, and more particularly thofe which 
Sagar employs in the character of plethora, 
never do occur but when the intumefcentia 
pinguedinofa has a great fhare in producing 
them. It is, however, very neceflary to ob- 
ferve here, that plethora and obefity are gen- 
erally combined together ; and that in fome 
cafes of corpulency it may be difficult to de- 
termine which of the caufes has the greateft 
fhare in producing it. It is indeed very pof- 
fible that a plethora may occur without great 
obefity ; but I apprehend that obefity never 
happens to a considerable degree without pro- 
ducing a plethora adfpatium in a great part 
of the fyftem of the aorta, and therefore a 
plethora ad molem in the lungs, and in the 
veffels of the brain. 

MDCXXIII. 

In attempting the cure of polyfarcia, I am 
of opinion, that the conjunction of plethora 
and obefity, in the manner juft now men- 
tioned, mould be conftantly attended to ; and 
when the morbid effe&s of the plethoric hab- 
it are threatened, either in the head or lungs, 
that bloodletting is to be prattifed : But at 
the fame time it is to be obferved, that per- 
fons of much obefity do not bear bloodletting 
well ; and when the circumftances I have 

mentioned 



244 PRACTICE 

mentioned do not immediately require it, the 
practice upon account of obefity alone, is 
hardly ever to be employed. The fame re- 
mark is to be made with refpecl: to any other 
evacuations that may be propofed for the 
cure of corpulency : For without the other 
means I am to mention, they can give but a 
very imperfect relief ; and, in fo far as they 
either empty or weaken the fyftem, they may 
favour the return of plethora, and the increafe 
of obefity. 

MDCXXIV. 

Polyfarcia, or corpulency, whether it de- 
pend upon plethora or obefity, whenever it 
either can be considered as a difeafe, or 
threatens to induce one, is to be cured, or the 
effe&s of it are to be obviated, by diet and 
exercife. The diet muft be {"paring ; or 
rather, what is more admiflible, it mufh be 
fuch as affords little nutritious matter. It 
mult therefore be chiefly, or almofl only, of 
vegetable matter, and at the very utmoft of 
milk. Such a diet mould be employed, and 
generally ought to precede exercife ; for obe- 
fity does not eafily admit of bodily exercife ; 
which is, however, the only mode that can be 
very effectual. Such, indeed, in many cafes, 
may feem difficult to be admitted ; but I am 
of opinion, that even the mod corpulent may 
be brought to bear it, by at firft attempting it 
very moderately, and increafing it by degrees 

very 



OF PHYSIC. 245 

very flowly, but at the fame time perfifting in 
fuch attempts with great conftancy. 

MDCXXV. 

As thefe, though the only effectual meaf- 
ures, are often difficult to be admitted or car- 
ried into execution, fome other means have 
been thought of and employed for reducing 
corpulency. Thefe, if I mi (lake not, have 
all been certain methods of inducing a faline 
ftate in the mafs of blood ; for fuch I fuppofe 
to be the effects of vinegar and of foap, which 
have been propofed. The latter, I believe, 
hardly paffes into the bloodveflels, without 
being refolved and formed into a neutral fait, 
with the acid which it meets with in the ftom- 
ach. How well acrid and faline fubftances 
are fitted to diminifh obefity, may appear 
from what has been faid above in MDCXV. 
What effects vinegar, foap, or other fub- 
ftances employed, have had in reducing cor- 
pulency, there have not proper opportunities 
of obferving occurred to me : But I am well 
perfuaded, that the inducing a faline and acrid 
ftate of the blood, may have worfe confe- 
quences than the corpulency it was intended 
to correct ; and that no perfon fhould hazard 
thefe, while he may have recourfe to the more 
fafe and certain means of abftinence and ex- 
eicife. 



CHAP. 



246 PRACTICE 

CHAP. II. 
of FLATULENT SWELLINGS. 

MDCXXVI. 

1 HE cellular texture of the 
human body very readily admits of air, and 
allows the fame to pafs from any one to every 
other part of it. Hence Emphyfemata have 
often appeared from air collected in the cel- 
lular texture under the fkin, and in feveral 
other parts of the body. The flatulent fwell- 
ings under the fkin, have indeed mod com- 
monly appeared in confequence of air imme- 
diately introduced from without : But in 
fome inftances of flatulent fwellings, efpec- 
ially thofe of the internal parts not commu- 
nicating with the alimentary canal, fuch an 
introduction cannot be perceived or fuppof- 
ed ; and therefore, in thefe cafes, fome other 
caufe of the production and collection of air 
muff, be looked for, though it is often not to 
be clearly afcertained. 

In every folid as well as every fluid fub- 
ftance which makes a part of the human body, 
there is a confiderable quantity of air in a 
fixed flate, which may be again reftored to 

its 






OF PHYSIC. 247 

its elaftic flate, and feparated from thofc fub- 
ftances, by the power of heat, putrefaction, 
and perhaps other caufe&: But which of thefe 
may have produced the feveral inftances of 
pneumatofis and flatulent fwellings that have 
been recorded by authors, I cannot pretend 
to afcertain. Indeed, upon account of thefe 
difficulties, I cannot proceed with any clear- 
nefs on the general iubje6t of pneumatofis ; 
and, therefore, with regard to flatulent fwell- 
ings, I find it neceflary to confine myfelf to 
the confideration of thofe of the abdominal 
legion alone ; which I fhall now treat of un- 
der the general name of Tympanites. 

MDCXXVII. 

The tympanites is a fwelling of the abdo- 
men ; in which the teguments appear to be 
much flretched by fome diftending power 
within, and equally flretched in every pofture 
of the body. The fwelling does not readily 
yield to any prefiure ; and in fo far as it dogs, 
very quickly recovers its former flate upon 
the preflure being removed. Being ftruck, it 
gives a found like a drum, or other flretched 
animal membranes. No fluctuation within 
is to be perceived : And the whole feels lefs 
weighty than might be expected from its bulk. 
The uneafmefs of the diftention is commonly 
relieved by the difcharge of air from the ali- 
mentary canal, either upwards or down- 
wards. 

MDCXXVIII. 



248 PRACTICE 



MDCXXVIII. 

Thefe ai* the characters by wliich the tym- 
panites may be diftinguifhed from the afcites 
or phyfconia ; and many experiments mow, 
that the tympanites always depends upon a 
preternatural collection of air, fomewhere 
within the teguments of the abdomen : But 
the feat of the air is in different cafes fome- 
what different ; and this produces the differ- 
ent fpecies of the difeafe. 

One fpecies is, when the air collected is 
entirely confined within the cavity of the ali- 
mentary canal, and chiefly in that of the in- 
teftines. This fpecies, therefore, is named 
the Tympanites intejlinalis, Sauv. fp. 1. It 
is, of all others, the moft common ; and to it 
efpecially belong the characters given above. 

A fecond fpecies is, when the air collected 
is not entirely confined to the cavity of the 
inteftines, but is alfo prefent between their 
coats ; and fuch is that which is named by 
Sauvages Tympanites enter ophyf odes, Sauv. fp. 
3. This has certainly been a rare occurrence ; 
and has probably occurred only in confe- 
quence of the tympanites intejlinalis, by the 
air efcaping from the cavity of the inteftines 
into the interftices of the coats. It is, how- 
ever, poflible that an erofion of the internal 
coat of the inteftines may give occafion to the 
air, fo conftantly prefent in their cavity, to 
efcape into the interftices of their coats, 

though 



*OF PHYSIC. 249 

though in the whole of their cavity there has 
been no previous accumulation. 

A third fpecies is, when the air is collected 
in the fac of the peritonaeum, or what is com- 
monly called the cavity of the abdomen, that 
is, the fpace between the peritonaeum and vif- 
cera j and then the difeafe is named Tympa- 
nites abdominaliSy Sauv. fp. 2. The exiftence 
of fuch a tympanites, without any tympanites 
inteJlinaliSy has been difputed ; and it certain- 
ly has been a rare occurrence : But from fev- 
eral diffe6lions, it is unqueftionable that fuch 
a difeafe has fometimes truly occurred. 

A fourth fpecies of tympanites is, when the 
tympanites intejlinalis and abdominalis are 
joined together, or take place at the fame 
time. With refpecl: to this, it is probable 
that the tympanites intejlinalis is the primary 
difeafe ; and the other, only a confequence 
of the air efcaping, by an erofion or rupture 
of the coats of the inteftines, from the cavity 
of thefe into that of the abdomen. It is in- 
deed poflible, that in confequence of erofion 
or rupture, the air which is fo conflantly pref- 
ent in the inteflinal canal, may efcape from 
thence in fuch quantity into the cavity of the 
abdomen, as to give a tympanites abdominalis % 
whilft there was no previous confiderable ac- 
cumulation of air in the inteflinal cavity it- 
felf ; but I have not fa£ts to afcertain this mat- 
ter properly. 

A fifth fpecies has alfo been enumerated. 
It is when a tympanites abdominalis happens 

to 



250 PRACTICE 

to be joined with the hydrops a/cites ; and 
fuch a difeafe therefore is named by Sauvages 
Tympanites afaticus, Sauv. fp. 4. In moft 1 
cafes of tympanites, indeed, fome quantity of 1 
ferum has, upon dilfe6lion, been found in the ' 
fac of the peritonaeum ; but that is not enough 
to conflitute the fpecies now mentioned ; and 
when the collection of ferum is more confid- 
erable, it is commonly where, both from the 
caufes which have preceded, and likewife 
from the fymptoms which attend, the afcites 
may be confidered as the primary difeafe ; 
and therefore that this combination does not 
exhibit a proper fpecies of the tympanites. 

MDCXXIX. 

As this lafl is not a proper fpecies, and as 
fome of the others are not only extremely 
rare, but even, when occurring, are neither 
primary, nor to be eafily diftinguifhed, nor, 
as confidered in themfelves, admitting of any 
cure, I fliall here take no further notice of 
them ; confining myfelf, in what follows, to 
the confideration of the moft frequent cafe, 
and aimoft. the only object of practice, the 
tympanites intejlinalis. 

MDCXXX. 

With refpect to this, I cannot perceive that 
it arifes in any peculiar temperament, or de- 
pends upon any predifpofition, which can be 

difcerned. 



OF PHYSIC. 251 

difcerned. It occurs in either lex, at every 
age, and frequently in young perfons. 



MDCXXXI. 

Various remote caufes of it have been af- 
figned : But many of thefe have not common- 
ly the effect of producing this difeafe ; and 
although fome of them have been truly ante- 
cedents of it, I can in few inflances difcover 
the manner in which they produce the dif- 
eafe, and therefore cannot certainly afcertain 
them to have been caufes of it. 



MDCXXXII. 

The phenomena of this difeafe in its feveral 
flages are the following. 

The tumour of the belly fometimes grows 
very quickly to a considerable degree, and 
feldom in the flow manner the afcites com- 
monly comes on. In fome cafes, however, 
the tympanites comes on gradually, and is 
introduced by an unufual flatulency of the 
ftomach and inteftines, with frequent borbo- 
rygmi, and an uncommonly frequent expul- 
fion of air upwards and downwards. This 
ftate is alfo frequently attended with colic 
pains, efpecially felt about the navel, and up- 
on the fides towards the back ; but generally 
as the difeafe advances, thefe pains become 
lefs confiderable. As the difeafe advances, 

there 



252 PRACTICE 

there is a pretty conftant defire to difcharge 
air, but it is accompliflied with difficulty ; and 
when obtained, although it give fome relief 
from the fenfe of didention, this relief is com- 
monly tranfient and of fhort duration. While 
the difeafe is coming on, fome inequality of 
tumour and tenfion may be perceived in dif- 
ferent parts of the belly ; but the didention 
foon becomes equal over the whole, and ex- 
hibits the phenomena mentioned in the char- 
after. Upon the firft coming on of the dif- 
eafe, as well as during its progrefs, the belly 
is bound, and the fasces difcharged are com- 
monly hard and dry. The urine, at the be- 
ginning, is ufually very little changed in 
quantity or quality from its natural Mate : But 
as the difeafe continues, it is commonly chang- 
ed in both refpe&s ; and at length fometimes 
a flranguary, and even an ifchuria, comes on. 
The difeafe has feldom advanced far, before 
the appetite is much impaired, and digeftion 
ill performed ; and the whole body, except 
the belly, becomes confiderably emaciated. 
Together with thefe fymptoms, a third and 
uneafy fenfe of heat at length come on, and a 
confiderable frequency of pulfe occurs, which 
continues throughout the courfe of the dif- 
eafe. When the tumour of the belly arifes 
to a confiderable bulk, the breathing becomes 
very difficult, with a frequent dry cough. 
With all thefe fymptoms the flrength of the 
patient declines ; and the febrile fymptoms 
daily increafing, death at length enfues, fome- 
times 



OF PHYSIC. 253 

times probably in confequence of a gangrene 
coming upon the inteftines. 

MDCXXXIII. 

The tympanites is commonly of fome du- 
ration, and to be reckoned a chronic difeafe. 
It is very feldom quickly fatal, except where 
luch an affection fuddenly arifcs in fevers. 
To this Sauvages has properly given a differ- 
ent appellation, that of Mcteorifmus ; and I 
judge it may always be confidered as a fymp^ 
tomati-c affection, entirely diflincl; from the 
tympanites we are now confidering. 

MDCXXXIV. 

The tympanites is generally a fatal difeafe, 
feldom admitting of cure - but what may be 
attempted in this way, I fhall try to point 
out, after I fhall have endeavoured to explain 
the proximate caufe, which alone can lay the 
foundation of what may be rationally attempt- 
ed towards its cure. 

MDCXXXV. 

To afcertain the proximate caufe of tym- 
panites, is fomewhat difficult. It has been 
luppofed in many cafes, to be merely an un- 
common quantity of air prefent in the ali- 
mentary canal, owing to the extrication and 
detachment of a greater quantity of air than 

Vol. III. M ufual 



fl £4 PRACTICE 

ufual from the alimentary matters taken in, 
,% Our vegetable aliments, I believe, always un- 
dergo fome degree of fermentation ; and in 
confequence, a quantity of air is extricated 
and detached from them in the ftomach and 
mteflines : But it appears, that the mixture 
of the animal fluids which our aliments meet 
ivith in the alimentary canal, prevents the 
fame quantity of air from being detached from 
them that would have been in their fermen- 
tation without fuch mixture ; and it is prob- 
able that the fame mixture contributes alfo to 
the reabforption of the air that had been be- 
fore in fome meafure detached. The extri- 
cation, therefore, of an unufual quantity of 
air from the aliments, may, in certain circum- 
flances, be fuch, perhaps, as to produce a 
tympanites ; fo that this difeafe may depend 
upon a fault of the digeftive, fluids, whereby 
they are unfit to prevent the too copious ex- 
trication of air, and unfit alfo to occafion that 
reabforption of air which in found perfons 
■commonly happens. An unufual quantity 
of air in the alimentary canal, whether owing 
to the nature of the aliments taken in, or to 
the fault of the digeftive fluid, does certainly 
fometimes take place ; and may poflibly have, 
and in fome meafure certainly has, a fhare in 
producing certain flatulent diforders of the al- 
imentary canal ; but cannot be fuppofed to 
produce the tympanites, which often occurs 
when no previous diforder had appeared in 
the fyftem. Even in thofe cafes of tympa- 
v nitcs 



OF PHYSIC. 255 

nites which are attended at their beginning 
with flatulent diforders in the whole of the 
alimentary canal, as we know that a firm tone 
of the inteflines both moderates the extrica- 
tion of air, and contributes to its reabforption 
or ready expulfion, fo the flatulent fymptoms 
which happen to appear at the coming on of 
a tympanites, are, in my opinion, to be refer- 
red to a lofs of tone in the mufcular fibres of 
the inteftines, rather than to any fault in the 
digeflive fluids, 

MDCXXXVI. 

Thefe, and other confiderations, lead me 
to conclude, that the chief part of the proxi- 
mate caufe of tympanites, is a lofs of tone ia 
the mufcular fibres of the inteflines. But 
further, as air of any kind accumulated in the 
cavity of the inteftines fhould, even by its 
own elafticity, find its way either upwards or 
downwards, and fhould alfo, by the afliftance 
of infpiration, be entirely thrown out of the 
body ; fo, when neither the reabforption nor 
the expulfion takes place, and the air is accu- 
mulated fo as to produce tympanites, it is 
probable that the paflage of the air along the 
courfe of the inteftines is in fome places of 
thefe interrupted. This interruption, how- 
ever, can hardly be fuppofed to proceed from 
any other caufe than fpafmodic conftric~lions 
in certain parts of the canal ; and I conclude, 
therefore, that fuch conftri&ions concur as 
M 2 part- 



256 PRACTICE 

part in the proximate caufe of tympanites. 
Whether thefe fpafmoclic conftri&ions are to 
be attributed to the remote caufe of the dif~ 
eafe, or may be confidered as the confequencc 
of iome degree of atony firft arifmg, I cannot 
with certainty, and do not find it neceflary to 
•determine. 

MDCXXXVII. 

Having thus endeavoured to afcertain the 
"proximate caufe of tympanites, I proceed to 
treat of its cure ; which indeed has feldom 
fucceeded, and almofl never but in a recent 
difeafe. I muft, however, endeavour to fay 
what may be reafonably attempted ; what has 
commonly been attempted ; and what at- 
tempts have fometimes fucceeded in the cure 
of this difeafe* 

MDCXXXVlIf. 

It muft be a firft indication to evacuate the 
air accumulated in the interlines : And for 
this purpofe it is neceflary that thofe conftrio 
tions, which had efpecially occafioned its ac- 
cumulation, and continue to interrupt its paf- 
fage along the courfe of the interlines, fhould 
be removed. As thefe, however, can hardly 
be removed but by exciting the periftaltic 
motion in the adjoining portions of the intek 
tines, purgatives have been commonly em- 
ployed ; but it is at the fame time agreed) 
*»* that 



OF PHYSIC. 257 

that the more gentle laxatives only ought to 
be employed, as the more draflic, in the over 
ftretched and tenfe ftate of the interlines, are 
in danger of bringing on inflammation. 

It is for this reafon alfo, that glyflers have 
been frequently employed ; and they are the 
more neceffary, as the fasces collected are gen- 
erally found to be in a hard and dry ftate. 
Not only upon account of this ftate of the 
fasces, but, farther, when glyllers produce a 
confiderable evacuation of air, and thus fhow 
that they have fome effect in relaxing the, 
fpafms of the interlines, they ought to be re- 
peated very frequently. 



MDCXXXIX. 



In order to take off the conff rictions of the 
inteftines, and with fome view alfo to the car- 
minative effects of the medicines, various an- 
tii'pafmodics have been propofed, and com- 
monly employed - r but their effects are fel- 
dom confiderable, and it is alleged that their 
heating and inflammatory powers have fome- 
times been hurtful. It is, however, always 
proper to join fome of the milder kinds with 
both the purgatives and glyflers that are em- 
ployed ; and it has been very properly advif- 
ed to give always the chief of antifpafmodics, 
that is, an opiate, after the operation of pur- 
gatives is finifhed. 

M 3 MDCXL. 



358 PRACTICE 



MDCXL. 

In confideration of the overftretched, tenfe, 
and dry ftate of the interlines, and efpecially 
of the fpafmodic conftricTJons that prevail, fo- 
mentations and warm bathing have been pro- 
posed as a remedy ; and are (aid to have been 
employed with advantage : But it has been 
Temarked, that very warm baths have not 
been found fo ufeful as tepid baths long con- 
tinued. 

MDCXLI. 

Upon the fuppofition that this difeafe de- 
pends efpecially upon an atony of the ali- 
mentary canal, tonic remedies feem to be 
properly indicated. Accordingly chalybe- 
ates, and various bitters, have been employ- 
ed ; and, if any tonic, the Peruvian bark 
might probably be ufeful. 

MDCXLII. 

But as no tonic remedy is more powerful 
than cold applied to the furface of the body, 
and cold drink thrown into the ftomach ; fo 
fuch a remedy has been thought of in this dif- 
eafe. Cold drink has been conftantly pre- 
fcribed, and cold bathing has been employed 
with advantage ; and there have been feveral 
inftances of the difeafe being fuddenly and 

entirely 



OF PHYSIC. 259 

entirely cured by the repeated application of 
(now to the lower belly. 

MDCXLIII. 

It is hardly neceffary to remark, that, in 
the diet of tympanitic perfons, all forts of food 
ready to become flatulent in the ftomach are 
to be avoided ; and it is probable, that the 
foihl acids and neutral falts, as antizymics, 
may be ufeful. 

MDCXLIV. 

In obflinate and defperate cafes of tym- 
panites, the operation of the paracentefis has- 
been propofed : But it is a very doubtful 
remedy, and there is hardly any teftimony of 
its having been praclifed with fuccefs. It 
mud be obvious, that this operation is a rem- 
edy fuited efpecially, and almoft only, to the 
tympanites abdommalis ; the exiftence of which, 
feparately from the intejlinalis, is very doubt- 
ful, at leafl not eafily afcertained. Even if 
its exiftence could be afcertained, yet it is not 
very likely to be cured by this remedy : And 
how far the operation might be fafe in the 
tympanites intejlinalis, is not yet determined 
by any proper experience. 



M 4 CHAP. 



260 PRACTICE 



CHAP. III. 



• f WATERY SWELLINGS, or DROP- 
SIES. 



MDCXLV. 

A PRETERNATURAL col- 
lection of ferous or watery fluids, is often 
formed in different parts of the human body ; 
and although the difeafe thence arifing be 
diftinguifhed according to the different parts 
which it occupies, yet the whole of fuch col- 
lections come under the general appellation 
of Dropfies. At the fame time, although the 
particular inftances of fuch collection are to 
be diftinguifhed from each other according to 
the parts they occupy, as well as by other cir- 
cumflances attending them ; yet all of them 
feem to depend upon fome general caufes, 
very much in common to the whole. Before 
proceeding, therefore, to confider the fevcral 
fpecies, it may be proper to endeavour to af- 
fign the general caufes of dropfy. 

MDCXLVI. 

In perfons in health, a ferous or watery 

fluid feems to be conftantly poured out, or 

Mfch. exhaled 



OF PHYSIC. 261 

exhaled in vapour, into every cavity and in- 
terface of the human body capable of receiv- 
ing it ; and the fame fluid, without remaining 
long or being accumulated in thefe fpaces, 
feems conftantly to be foon again ablorbed 
from thence by veffels adapted to the pur- 
pofe. From this view of the animal econo- 
my, it will be obvious, that if the quantity 
poured out into any fpace, happens to be 
greater than the abforbents can at the fame 
time take up, an unufual accumulation of fe- 
rous fluid will be made in fuch parts ; or 
though the quantity poured out be not more 
than ufual, yet if the abforption be any wife 
interrupted or diminifhed, from this caufe al- 
io an unufual collection of fluids may be oc- 
casioned. 

Thus, in general, dropfy may be imputed 
to an increafed efFufion, or to a diminifhed 
abforption ; and I therefore proceed to in- 
quire into the feveral caufes. of thefe. 

MDCXLVH. 

An increafed efFufion may happen, either 
from a preternatural increafe of the ordinary 
exhalation, or from the rupture of veffels car- 
rying, or of facs containing, ferous or watery 
fluids. 

MDCXLVIII. 

The ordinary exhalation may be increafed 

by various caufes, and particularly by an in- 

Vol. 3. M 5 tcrruption 



-G-2 PRACTICE 

t.:rruption given to the free return of the ve- 
nous blood from the extreme vefTels of the 
body to the right ventricle of the heart. This 
interruption feems to operate by refilling the 
free pallage of the blood from the arteries into 
the veins, thereby increafing the force of the 
arterial fluids in the exhalants, and confe- 
quently the quantity of fluid which they 
pour out. 

MDCXLIX. 

The interruption of the free return of the 
venous blood from the extreme vefTels, may 
be owing to certain circumftances afFe&ing 
the courfe of the venous blood ; very fre- 
quently, to certain conditions in the right 
ventricle of the heart itfelf, preventing it from 
receiving the ufual quantity of blood from 
the vena cava ; or to obftruttions in the vefTels 
of the lungs preventing the entire evacuation 
of the right ventricle, and thereby hindering 
its receiving the ufuai quantity of blood from 
the cava. Thus, a polypus in the right ven- 
tricle of the heart, and the edification of its 
valves, as well as all confiderable and perma- 
nent obftruclions of the lungs, have been 
found to be caufes of dropfy. 

MDCL. 

It may ferve as an illuftration of the ope- 
ration of thefe general caufes, to remark, that 

the 



OF P PI Y S I C. 263 

the return of the venous blood is in Come 
meafure refitted when the pofture of the body 
is fuch as gives occafion to the gravity of the 
blood to oppofe the motion or it in the veins, 
which takes effect when the force of the cir- 
culation is weak ; and from whence it is that 
an upright poflure of the body produces or 
increafes ferous fwellings in the lower extrem- 
ities. 

MDCLI. 

Not only thofe caufes interrupting the mo- 
tion of the venous blood more generally, but, 
farther, the interruption of it in particular 
veins, may likewife have the effecl: of increaf- 
ing exhalation, and producing dropfy. The 
mofl remarkable inftance of this is, when con- 
siderable obftructrons of the liver prevent the 
blood from flowing freely into it from the 
vena portarum and its numerous branches ; 
and hence thefe obstructions are a frequent 
caufe of dropfy. 

MDCLII. 

Scirrhofities of the fpleen and other vifccra, 
as well as the fcirrhofity of the liver, have 
been confidered as caufes of dropfy ; but the 
manner in which they can produce the dif- 
cale, I do not perceive, except it may be 
where they happen to be near fome confid- 
crable vein, by the compreffion of which they 
may occafion fome degree of afcites ; or, by 
M 6 com pre fling 



264 PRACTICE 

compreffing the vena cava, may produce an 
anafarca of the lower extremities. It is in- 
deed true, that fcirrhofities of the fpleen and 
other vifcera, have been frequently discover- 
ed in the bodies of hydropic perfons : But I 
believe they have been feldom found unlefs 
when fcirrhofities of the liver were alio pref- 
ent ; and I am inclined to think, that the 
former have been the effects of the latter, 
rather than the caufe of the dropfy ; or that, 
if fcirrhofities of the other vifcera have ap- 
peared in hydropic bodies when that of the 
liver was not prefent, they mufl have been 
the effects of fome of thofe caufes of dropfy 
to be hereafter mentioned ; and confequently 
to be the accidental attendants, rather than 
the caufes, of fuch dropfies. 

MDCLIII. 

Even in fmaller portions of the venous 
fyftem, the interruption of the motion of the 
blood in particular veins has had the fame ef- 
fect. Thus, a polypus formed in the cavity 
of a vein, or tumours formed in its coats, pre- 
venting the free paffage of the blood through 
it, have had the effect of producing dropfy 
in parts towards the extremity of fuch veins. 

MDCLIV. 

But the caufe moft frequently interrupting 
the motion of the blood through the veins is, 
the compreffion of tumours exifting near to 

them; 



OF PHYSIC. 265 

them ; fuch as aneurifms in the arteries, ab- 
fcefles, and fcirrhous or fteatomatous tumours 
in the adjoining parts. 

To this head, may be referred, the com- 
preflion of the defcending cava by the bulk 
of the uterus in pregnant women, and the 
compreflion of the fame by the bulk of water 
in the afcites ; both of which compreflions fre- 
quently produce ferous fwellings in the lower 
extremities. 

MDCLV. 

It may be fuppofed, that a gtneral preter- 
natural plethora of the venous fyftem may 
have the effecT; of increafmg exhalation ; and 
that this plethora may happen from the fup- 
preffion of fluxes, or evacuations of blood, 
which had for fome time taken place in the 
body, fuch as the menftrual and hemorrhoidal 
fluxes. A dropfy, however, from fuch a 
caufe, has been at leafl a rare occurrence ; 
and when it feems to have happened, I fhould 
fuppofe it owing to the fame caufes as the 
fuppreffion itfelf, rather than to the plethora 
produced by it. 

MDCLVI. 

^ One of the moft frequent caufes of an ir>- 
creafed exhalation, I apprehend to be the 
laxity of the exhalant veffels. That fuch a 
caufe may operate, appears probable from 
this, that paralytic limbs, in which fuch a lax- 
ity 



±66 PRACTICE 

icy is to be fufpe&cd, are frequently affected 
with ferous, or, as they are called, cedematous 
fwellings. 

But a much more remarkable and frequent 
example of its operation occurs in the cafe of 
a general debility of the fyftem, which is fo 
often attended with dropfy. That a general 
debility does induce dropfy, appears fuffi- 
ciently from its being fo commonly the confe- 
quence of powerfully debilitating caufes ; 
fuch as fevers, either of the continued or in- 
termittent kind, which have lafted long ; long 
continued and fomewhat exceffive evacuations 
of any kinds ; and, in fhort, almoft all difeafes 
that have been of long continuance, and have 
at the fame time induced the other fymptoms 
.of a general debility. 

Among other caufes inducing a general de- 
bility of the fyftem, and thereby dropfy, there 
is one to be mentioned as frequently occur- 
ring, and that is, intemperance in the ufe of 
intoxicating liquors ; from whence it is that 
drunkards of all kinds, and efpecially dram 
drinkers, are fo affected with this difeafe. 

MDCLVII. 

That a general debility may produce a lax- 
ity of the exhalants, will be readily allowed ; 
and that by this efpecially it occafions drop- 
fy, I judge from thence, that while molt of 
the caufes already mentioned are fuited to 
produce dropfies of particular parts only, the 

' flare 



OF PHYSIC. 267 

ftate of general debility gives rife to an in- 
creafed exhalation into every cavity and in- 
terftice of the body, and therefore brings on a 
general difeafe. Thus, we have feen effu- 
fions of a ferous fluid made, at the fame time, 
into the cavity of the cranium, into that of 
the thorax and of the abdomen, and likewife 
into the cellular texture almoft over the whole 
of the body. In fuch cafes, the operation of 
a general caufe difcovered itfelf, by thefe fev- 
eral dropfies increafmg in one part as they 
diminished in another, and this alternately in 
the different parts. This combination, there- 
fore, of the different fpecies of dropfy, or 
rather, as it may be termed, this univerfal 
dropfy, muff, I think, be referred to a general 
caufe ; and in moft inflances, hardly any oth- 
er can be thought of, but a general laxity of 
the exhalants. It is this, therefore, that I call 
the hydropic diathefis ; which frequently ope- 
rates by itfelf ; and frequently, in fome meaf- 
ure, concurring with other caufes, is efpecial- 
ly that which gives them their full effect. 

This ftate of the fyftem, in its firfl appear- 
ance, feems to be what has been confidered as 
a particular difeafe under the name of Cachexy ; 
but in every inftance of it that has occurred 
to me, I have always confidered, and have al- 
ways found, it to be the beginning of general 
dropfy. 

MDCLVIII. 

The feveral caufes of dropfy already men- 
tioned may produce the difeafe, although 

there 



268 PRACTICE 

there be no preternatural abundance of ferous 
or watery fluid in the bloodveflels ; but it is 
now to be remarked, that a preternatural 
abundance of that kind may often give occa- 
fion to the difeale, and more especially when 
fuch abundance concurs with the caufes above 
enumerated. 

One caufe of fuch preternatural abundance 
may be an unufual quantity of water taken 
into the body. Thus an unufual quantity of 
water taken in by drinking, has fometimes or- 
cafioned a dropfy. Large quantities of water, 
it is true, are upon many occafions taken in ; 
and being as readily thrown out again by 
ftool, urine, or perfpiration, have not pro- 
duced any difeafe. But it is alfo certain, 
that, upon fome occafions, an unufual quan- 
tity of watery liquors taken in has run off by 
the feveral internal exhalants, and produced 
a dropfy. This feems to have happened, ei- 
ther from the excretories not being fitted to 
throw out the fluid fo fart as it had been taken 
in, or from the excretories having been ob- 
ftruclied by accidentally concurring caufes. 
Accordingly it is faid, that the fudden taking 
in of a large quantity of very cold water, has 
produced dropfy, probably from the cold 
producing a conflriclion of the excretories. 

The proportion of watery fluid in the blood 
may be increafed, not only by the taking in a 
large quantity of water by drinking, as now 
mentioned, but it is poffible that it may be in- 
creafed alfo by water taken in from the at- 

mofphere 



OF PHYSIC. 269 

mofphere by the fkin in an abforbing or im- 
bibing ftatc. It is well known that the (kin 
may be, at leaft, occasionally in fuch a flate ; 
and it is probable, that in many cafes of be- 
ginning dropfy, when the circulation of the 
blood on the furface of the body is very lan- 
guid, that the fkin may be changed from a 
perfpiring, to an imbibing, flate ; and thus, 
at leaft, the difeafe may be very much in- 
creafed. 

MDCLIX. 

A fecond caufe of a preternatural abund- 
ance of watery fluids in the bloodveffels, may 
be, an interruption of the ordinary watery ex- 
cretions ; and accordingly it is alleged, that 
perfons much expofed to a cold and moid air 
are liable to dropfy. It is alfo faid, that an 
interruption, or confiderable diminution, of 
the urinary fecretion, has produced the dif- 
eafe : And it is certain, that, in the cafe of an 
ifchuria renalis, the ferofity retained in the 
bloodvefTels has been poured out into fome 
internal cavities, and has occauoned dropfy. 

MDCLX. 

A third caufe, of an over proportion of fe- 
rous fluid in the blood ready to run off by the 
exhalants, has been very large evacuations of 
blood, either Spontaneous or artificial. Thefe 
evacuations, by abftra&ing a large proportion 

of 



270 PRACTICE 

of red globules and gluten, which arc the 
principal means of retaining ferum in the red 
veffels, allow the ferum to run off more read- 
ily by the exhalants : And hence dropfies 
have been frequently the confequence of fuch 
evacuations. 

It is poffible alfo, that large and long con- 
tinued iffues, by abftra&ing a large proporw 
don of gluten, may have the fame effe6t. 

An over proportion of the ferous parts of 
the blood, may not only be owing to the Jpo- 
Uation'yiR. now mentioned, but may, I appre- 
hend, be likewife owing to a fault in the di- 
gefting and afTimilating powers in the ftomach 
and other organs ; whereby they do not pre- 
pare and convert the aliments taken in, in 
fuch a manner as to produce from them the 
due proportion of red globules and gluten ; 
but, ftill continuing to fupply the watery 
parts, occafion thefe to be in an over propor- 
tion, and confequently ready to run off in too 
large quantity by the exhalants. It is in 
this manner that we explain the dropfy, fo 
often attending chlorous : Which appears al- 
ways at firft by a pale colour of the whole 
body, mowing a manifefl deficiency of red 
blood ; which in that difeafe can only be at- 
tributed to an imperfect; digeftion and aflim- 
ilation. 

Whether a like imperfection takes place in 
what has been called a Cachexy, I dare not 
determine. This difeafe indeed has been 
commonly and very evidently owing to the 

general 



OF PHYSIC. 271 

general caufes of debility above mentioned : 
And it being probable that the general debil- 
ity may affecl: the organs of digeftion and af- 
fimilation ; fo the imperfect ftate of thefe 
functions, occafioning a deficiency of red 
globules and gluten, may often concur with 
the laxity ©f the exhalants in producing 
dropfy. 

MDCLXI. 

Thefe are the feveral caufes of increafed 
exhalation, which I have mentioned as the 
chief caufe of the effufion producing dropfy ; 
but I have likewife obferved in MDCXLVII, 
that with the fame effecl:, an effufion may alfo 
be made by the rupture of veffels carrying 
watery fluids. 

In this way, a rupture of the thoracic du&, 
has given occafion to an effufion of chyle and 
lymph into the cavity of the thorax ; and a 
rupture of the la&eals has occafioned a like 
effufion into the cavity of the abdomen ; and 
in either cafe, a dropfy has been produced. 

It is fufnciently probable, that a rupture 
of lymphatics, in confequence of {trains, or 
the violent compreffion of neighbouring muf- 
cles, has occafioned an effufion ; which, be- 
ing diffufed in the cellular texture, has pro- 
duced dropfy. 

It belongs to this head of caufes, to remark, 
that there are many inftances of a rupture or 
crofion of the kidneys, ureters, and bladder 

of 

J 



272 PRACTICE 

of urine ; whereby the urine has been pour- 
ed into the cavity of the abdomen, and pro- 
duced an afcites. 

MDCLXII. 

Upon this fubjett, of the rupture of veflels 
carrying, or of veficles containing, watery flu- 
ids, I muft obferve, that the diffettion of dead 
bodies has often mown veficles formed upon 
the furface of many of the internal parts ; and 
it has been fuppofed, that the rupture of fuch 
veficles, commonly named Hydatidcs, together 
with their continuing to pour out a watery 
fluid, has been frequently the caufe of dropfy. 
I cannot deny the poffibility of fuch a caufe, 
but fufpect the matter muft be explained in a 
different manner. 

There have been frequently found, in al- 
moft every different part of animal bodies, 
collections of fpherical veficles, containing a 
watery fluid ; and in many cafes of fuppofed 
dropfy, particularly in thofe called the pre- 
ternatural encyfled dropfies, the fwelling has 
been entirely owing to a collection of fuch 
hydatides. Many conjectures have been 
formed with regard to the nature and pro- 
duction of thefe veficles ; but the matter at 
lafl feems to be afcertained. It feems to be 
certain, that each of thefe veficles has within 
it, or annexed to it, a living animal of the 
worm kind ; which feems to have the power 
of forming a veficle for the purpofe of its own 

economy, 






OF PHYSIC. 273 

economy, and of filling it with a watery fluid 
drawn from the neighbouring parts : And 
this animal has therefore been properly named 
by late naturalifts, the Taenia hydatigena. 
The origin and economy of this animal, or an 
account of the feveral parts of the human 
body which it occupies, I cannot profecute 
further here ; but it was proper for me, in de- 
livering the caufes of dropfy, to fay thus much 
of hydatides : And I mufl conclude with ob- 
serving, I am well perfuaded, that mod of the 
inftances of preternatural encyfted dropfies 
which have appeared in many different parts 
of the human body, have been truly collec- 
tions of fuch hydatides ; but how the fwell- 
ings occafioned by thefe are to be diflinguifh- 
ed from other fpecies of dropfy, or how they 
are to be treated in practice, I cannot at pref- 
ent determine. 



MDCLXIII. 



After having mentioned thefe, I return to 
confider the other general caufe of dropfy, 
which I have faid in MDCXLVI maybe, 
An interruption or diminution of the absorp- 
tion that mould take up the exhaled fluids 
from the feveral cavities and interfaces of the 
body ; the caufes of which interruption, how- 
ever, are not eafily afcertained. 

MDCLXIV, 



274 PRACTICE 



MDCLXIV. 

It feems probable, that abforption may be 
diminifhed, and even ceafe altogether, from a 
lofs of tone in the abforbent extremities of 
the lymphatics. I cannot indeed doubt that 
a certain degree of tone or aftive power is 
neceffary. in thefe abforbent extremities ; and 
it appears probable, that the fame general de- 
bility which produces that laxity of the ex- 
halant veflels, wherein I have fuppofed the 
hydropic diathefis to confift, will at the fame 
time occafion a lofs of tone in the abforbents ; 
and therefore that a laxity of the exhalants 
will generally be accompanied with a lofs of 
tone in the abforbents ; and that this will 
have a fhare in the production of dropfy. 
Indeed it is probable that the diminution of 
abforption has a confiderable fhare in the 
matter ; as dropfies are of»:n cured by med- 
icines which feem to operate by exciting the 
ac~lion of the abforbents. 

MDCLXV. 

It has been fuppofed, that the abforption 
performed by the extremities of lymphatics 
may be interrupted by an obftruclion of thefe 
Veffels, or at leaft of the conglobate glands 
through which thefe veffels pafs. This, how- 
ever, is very doubtful. As the lymphatics 
have branches frequently communicating 

with 



OF PHYSIC. 275 

with one another, it is not probable that the 
obftru6lion of any one, or even feveral of 
thefe, can have any confiderable effect in in-, 
terrupting the abforption of their extremities. 

And for the fame reafon, it is as little prob- 
able that the obftruclion of conglobate glands 
can have fuch an effect : At lead it is only an 
obftruclion of the glands of the mefentery, 
through which fo confiderable a portion of 
the lymph paffes, that can poftibly have the 
effect of interrupting abforption. But even 
this we fhould not readily fuppofe, there be- 
ing reafon to believe that thefe glands, even 
in a confiderably tumefied ftate, are not en- 
tirely obftrudted : And accordingly I have 
known feveral inftances of the moft part of 
the mefenteric glands being confiderably tu- 
mefied, without either interrupting the tranf- 
milfion of fluids to the bloodveffels, or occa- 
iioning any dropfy. 

An hydropic fwelling, indeed, feems often 
to affect the arm from a tumour of the axil- 
lary gland : But it feems to me doubtful, 
whether the tumour of the arm may not be 
owing to fome compreflion of the axillary 
vein, rather than to an obftru&ion of the 
lymphatics. 



MDCLXVI. 



A particular interruption of abforption may 
be fuppofed to take place in the brain. As 
iio lymphatic veffels have yet very certainly 

been 



2jS PRACTICE 

been difcovered in that organ, it may be 
thought that the abforption, which certainly 
takes place there, is performed by the extrem- 
ities of veins, or by veffels that carry the fluid 
directly into the veins ; fo that any impedi- 
ment to the free motion of the blood in the 
veins of the brain, may interrupt the abforp- 
tion there, and occafion that accumulation of 
ferous fluid which fo frequently occurs from 
a congeftion of blood in thefe veins. But I 
give all this as a matter of conjecture only. 

MDCLXVII. 

Having thus explained the general caufes 
of dropfy, I fhould proceed, in the next place, 
to mention the feveral parts of the body in 
which ferous collections take place, and fo to 
mark the different fpecies of dropfy : But I 
do not think it neceflary for me to enter into 
any minute detail upon this fubject. In many 
cafes, thefe collections are not to be ascertain- 
ed by any external fymptoms, and therefore 
cannot be the objects, of practice ; and many 
of them, though in fome meafure difcernible, 
do not feem to be curable by our art. I the 
more efpecially avoid mentioning very par- 
ticularly the feveral fpecies, becaufe that has 
already been fufhciently done by Dr. D. 
Monro, and other writers, in every body's 
hands. I muft confjine myfelf here to the 
confideration of thofe fpecies which are the 
mofl frequently occurring and the moll com- 
mon 



OF PHYSIC. 277 

mon objefts of our pra£lice ; which are, the 
Anafarca, Hydroihorax, and Afcites ; and 
each of thefe I ihall treat in fo many feparate 
fe 61 ions. 



T. I. 



Of An asarca. 



MDCLXVIIL 

THE Anafarca is a fwelling upon the fur-* 
Face of the body, at firft commonly appearing 
in particular parts only, but at length fre- 
quently appearing over the whole. So far as 
it extends, it is an uniform fwelling over the 
whole member, at firft always foft, and read- 
ily receiving the preffure of the finger, which 
forms a hollow that remains for fome little 
time after the preffure is removed, but at 
length rifes again to its former fulnefs. This 
fwelling generally appears, firfl, upon the 
lower extremities ; and there too only in the 
evening, difappearing again in the morning. 
It is ufually more confiderable as the perfen 
has been more in an ere6l poilure during the 
day ; but there are many inftances of the ex- 
ercife of walking preventing altogether its oth- 
erwife ufual coming on. Although this 
fwelling appears at firft only upon the feet 

Vol. III. N and 



278 PRACTICE 

and about the ankles ; yet if the caufes pro- 
ducing it continue to aft, it gradually extend? 
upwards, occupying the legs, thighs, and 
trunk of the body, and fometimes even the 
head. Commonly the fweliing of the lower 
extremities diminifhes during the night ; and 
in the morning, the fweliing of the face is 
moll confiderable, which again generally dif- 
appears almoft entirely in the courfe of the 
day. 

MDCLXIX. 

The terms of Anafarca and Leucophlegmatia 
have been commonly confidered as fynony- 
mous ; but fome authors have propofed to 
confider them as denoting diftinct difeafes. 
The authors who are of this lafl opinion em- 
ploy the name of Anafarca for that difeafe 
which begins in the lower extremities, and is 
from thence gradually extended upwards in 
the manner I have jufl now defcribed ; while 
they term Leucophlegmatia, that in which the 
fame kind of fweliing appears even at firft 
very generally over the whole body. They 
feem to think alfo, that the two difeafes pro- 
ceed from different caufes ; and that, while 
the anafarca may arife from the feveral caufes 
in MDCXLVIII— MDCLIX, the leuco- 
phlegmatia proceeds efpecially from a defi- 
ciency of red blood, as we have mentioned in 
MDCLX et feq. I cannot, however, find 
any proper foundation for this diftinclion. 

For 



OF PHYSIC. 279 

For although in dropfies proceeding from the 
caufes mentioned in MDCLX etftq. the dif- 
eafe appears in fome cafes more immediately 
aife&ing the whole body ; yet that docs not 
rftablifh a difference from the common cafe 
of anafarca : For the difeafe, in all its circum- 
ltances, comes at length to be entirely the 
fame ; and in cafes occafioned by a deficiency 
of red blood, I have frequently obferved it to 
come on exactly in the manner of an anafar- 
ca, as above described. 

MDCLXX. 

An anafarca is evidently a preternatural 
collection of ferous fluid in the cellular tex- 
ture immediately under the Ikin. Some- 
times pervading the fkin itfelf, it oozes out 
through the pores of the cuticle ; and fome- 
times, too grofs to pafs by thefe, it raifes the 
cuticle in blifters. Sometimes the fkin, not 
allowing the water to pervade it, is comprefT- 
ed and hardened, and at the fame time fo 
much diftended, as to give anafarcous tu- 
mours an unufual firmnefs. It is in thefe 
laft circumftances alfo that an erythematic 
inflammation is ready to come upon anafar- 
cous fwellings. 'A 

MDCLXXI. 

An anafarca may immediately arife from 
any of the feveral caufes of dropfy which 

N 2 aft 



2 8o PRACTICE 

act; more generally upon the fyftem : And 
even when other fpecies of dropfy, from par- 
ticular circumftances, appear firft ; yet when- 
ever thefe proceed from any caules more gen- 
erally afFeciing the fyftem, an anafarca foon- 
ev or later comes always to be joined with 
them. 

MDCLXXII. 

The manner in which this difeafe common- 
ly firft appears, will be readily explained by 
what I have faid in MDCL refpe&ing the 
effects of the pofture of the body. Its grad- 
ual progrefs, and its affecting, after fome time, 
not only the cellular texture under the fkin, 
but probably alfo much of the fame texture 
in the internal parts, will be underftood part- 
ly from the communication that is readily 
made between the feveral parts of the cellular 
texture ; but efpecially from the fame general 
caufes of the difeafe producing their effects 
in every part of the body. It appears to me, 
that the water of anafarcous fwellings is more 
readily communicated to the cavity of the 
thorax, and to the lungs, than to the cavity of 
the abdomen, or to the vifcera contained 
in it. 

MDCLXXIII. 

An anafarca is almoft always attended with 
a fcarcity of urine ,• and the urine voided, is, 

from 



OF PHYSIC. 281 

from its fcarcity, always of a high colour ; and 
from the fame caufe, after cooling, readily lets 
fall a copious reddifh fediment. This fcar- 
city of urine may fometimes be owing to an 
obftru&ion of the kidneys ; but probably is 
generally occafioned by the watery parts of 
the blood running off into the cellular tex- 
ture, and being thereby prevented from pann- 
ing in the ufual quantity to the kidneys. 

The difeafe is alfo generally attended with 
an unufual degree of thirfl ; a circumflance I 
would attribute to a like abftra6lion of fluid 
from the tongue and fauces, which are ex- 
tremely fenfible to every diminution of the 
fluids in thefe parts. 

MDCLXXIV. 

The cure of anafarca is to be attempted 
upon three general indications. 

1. The removing the remote caufes of the 
difeafe. 

2. The evacuation of the ferous fluid al- 
ready collefted in the cellular texture. 

3. The refloring the tone of the fyftem, the 
lofs of which may be confidered in many cafes- 
as the proximate caufe of the difeafe. 

MDCLXXV. 

The remote caufes are very often fuch as 

hid not only been applied, but had alfo been 

removed, long before the difeafe came en. 

N 3 Although, 



282 PRACTICE 

Although, therefore, their effects remain, the 
caufes themfelves cannot be the objects of 
practice ; but if the caufes Mill continue to 
be applied, fuch as intemperance, indolence, 
and fome others, they mufl be removed. For 
the mofl part, the remote caufes are certain 
difeafes previous to the dropfy, which are to 
be cured by the remedies particularly adapt- 
ed to them, and cannot be treated of here. 
The curing of thefe, indeed, may be often 
difficult ; but it was proper to lay down the 
prefent indication, in order to fhow, that 
when thefe remote caufes cannot be remov- 
ed, the cure of the dropfy mufl be difficult, 
or perhaps impoflible. In many cafes, there- 
fore, the following indications will be to little 
purpofe ; and particularly, that often the ex- 
ecution of the fecond will not only give the 
patient a great deal of fruitlefs trouble, but 
commonly alfo hurry on his fate. 

MDCLXXVI. 

The fecond indication for evacuating the 
collected ferum, may be fometimes executed 
with advantage, and often, at leafl, with tem- 
porary relief. It may be performed in two 
ways. Firfl, by drawing off the water di- 
rectly from the dropfical part, by openings 
made into it for that purpofe : Or, fecondly, 
by exciting certain ferous excretions ; in con- 
fequence of which, an abforption may be ex- 
cited in the dropfical parts, and thereby the 

ferum 



OF PHYSIC. 283 

ferum absorbed and carried into the blood- 
veflels, may afterwards be directed to run out, 
or may fpontaneoufly pafs out, by one or oth- 
er of the common excretions 

MDCLXXVII. 

In an anafarca, the openings into the drop- 
fical part are commonly to be made in fome 
part of the lower extremities ; and will be 
moft properly made by many fmall punttures 
reaching the cellular texture. Formerly; 
confiderable incifions were employed for this 
purpofe : But as any wound made in- drop- 
fical parts, which, in order to their healing, 
muft neceflarily inflame and luppurate, are 
liable to become gangrenous ; fo it is found 
to be much fafer to make the openings by 
{mall punttures only, which may heal up by 
the firft intention. At the fame time, even 
with refpeel: to thefe punctures, it is proper 
to obferve, that they mould be made at fome 
diftance from one another, and that care 
mould be taken to avoid making them in the 
mod depending parts. 

MDCLXXVIII. 

The water of anafarcous limbs may be 
fometimes drawn off by pea iflues, made by 
cauftic a little below the knees : For as the 
great fwelling of the lower extremities is chief- 
ly occalioned by the ferous fluid exhaled into 
N a the 



s«4 PRACTICE 

the upper parts conftantly falling down to 
the lower ; fo the iffues now mentioned, by 
evacuating the water from thefe upper parts, 
may very much relieve the whole of the dif. 
eafe. Unlefs, however, the iffues be put in 
before the difeafe is far advanced, and before 
the parts have very much loft their tone, the 
places of the i flues are ready to become af- 
fected with gangrene. 

Some practical writers have advifed the 
employment of fctons for the fame purpofe 
that I have propofed iffues ; but I apprehend, 
that fetons will be more liable than iffues to 
the accident juft now mentioned. 

MDCLXXIX. 

For the purpofe of drawing out ferum from 
anafarcous limbs, blifters have been applied 
to them, and fometimes with great fuccefs ; 
but the bliftered parts are ready to have a 
gangrene come upon them. Bliflering is 
therefore to be employed with great caution ; 
and perhaps only in the circumftances that I 
have mentioned above to be fit for the em- 
ployment of iffues. 

MDCLXXX. 

Colewort leaves applied to the fkin, readily 
occafion a watery exfudation from its furface ; 
and applied to the feet and legs affected with 

arfcfarca, 



O F ? II Y S I C. 285 

anafarca, have fometimes drawn off the water 
vei*) r copioufly, and with great advantage. 

Analogous, as I judge, to this, oiled filk 
hofe put upon the feet and legs, lb as to flmt 
out all communication with the external air, 
have been found fometimes to draw a quanti- 
ty of water from the pores of the fkin, and are 
faid in this way to have relieved anafarcous 
fwellings : But in leveral trials made, I have 
never found either the application of thefe 
hofe, or that of the colewort leaves, of much 
icrvice. 

MDCLXXXI. 

The 2d means propofed in MDCLXXVI 
for drawing off the water from dropfical 
places, may be the employment of emetics, 
purgatives, diuretics, or fudorifics. 

MDCLXXXII. 

As fpontaneous vomiting has .fometimes 
excited an abforption in hydropic parts, and 
thereby drawn off the waters lodged in them, 
it is reafonable to fuppofe that vomiting ex- 
cited by art may have the fame effec~r ; and 
accordingly it has been often praclifed with 
advantage. The practice, however, requires 
that the ftrong antimonial emetics be em- 
ployed, and that they be repeated frequently 
after fhort intervals. 

Vol. 3. N5 MDCLXXXIII. 

I 



286 PRACTICE 



MDCLXXXIII. 

Patients fubmit more readily to the ufe of 
purgatives, than to that of emetics ; and in- 
deed they commonly bear the former more 
eafily than the latter. At the fame time, 
there are no means we can employ to pro- 
cure a copious evacuation of lerous fluids 
with greater certainty than the operation of 
purgatives ; and it is upon thefe accounts 
that purging is the evacuation which has been 
moft frequently, and perhaps with mod fuc- 
cefs, employed in dropfy. It has been gen- 
erally found neceffary to employ purgatives 
of the more draftic kind ; which are common- 
ly known, and need not be enumerated here. 
I believe indeed, that the more draftic pur- 
gatives are the moft effectual for exciting 
abforption, as their ftimulus is moft readily 
communicated to the other parts of the fyf- 
tem j but of late an opinion has prevailed, 
that fome milder purgatives may be employ- 
ed with advantage. This opinion has pre- 
vailed particularly with regard to the cryftals 
vulgarly called the Cream of Tartar, which in 
large dofes, frequently repeated, have fome- 
times anfwered the purpofe of exciting large 
evacuations both by ftool and urine, and has 
thereby cured dropfies. This medicine, 
however, has frequently failed, both in its 
operation and effects, when the draftic pur- 
gatives have been more fuccefsfuJ. 

Practitioners 






OF PHYSIC. 287 

Pra&itioners have long ago obferved, that, 
in the employment of purgatives, it is requi- 
(ite they be repeated after as fhort intervals- 
as the patient can bear ; probably for this 
reafon, that when the purging is not carried 
to the degree of foon exciting an abforption, 
the evacuation weakens the fyftem, and there- 
by increafes the afflux of fluids to the hv~ 
dropic parts. 

MDCLXXXIV. 

The kidneys afford a natural outlet for a 
great part of the watery fluids contained in 
the bloodveflels ; and the increafing the ex- 
cretion by the kidneys to a considerable de- 
gree, is a means as likely as any other of ex- 
citing an abforption in dropfical parts. It is 
upon this account that diuretic medicines have 
been always properly employed in the cure of 
dropfy. The various diuretics that may be 
employed, are enumerated in every treatife of 
the Materia Medica and of the Practice of 
Phylic, and therefore need not be repeated 
here. It happens, however, unluckily, that 
none of them are of very certain operation ; 
neither is it well known why they fometimfcs 
fucceed, and why they fo often fail ; nor why 
one medicine mould prove of fervice when 
another does not. It has been generally the 
fault of writers upon the Practice of Phyfic, 
that they give us inftances of cafes in whicli 
certain medicines have proved very effica- 
N 6 ciousj 



PRACTICE 

nous, but neglect to tell us in how many oth- 
er inflanc- s the lame have failed. 

MDCLXXXV. 

It deferves to be particularly obferved here, 
that there is hardly any diuretic more certain- 
ly powerful than a large quantity of common 
water taken in by drinking. I have indeed 
obferved above in MDCLVIII, that a large 
quantity of water, or of watery liquors, taken 
in by drinking, has fometimes proved a caufe 
of dropfy ; and practitioners have been for-*- 
merly fo much afraid that watery liquors tak- 
en in by drinking might run off into dropfical 
places and increafe the difeafe, that they have 
generally enjoined the abflaining as much as 
poflible, from fuch liquors. Nay, it has been 
further alferted, that by avoiding this fupply 
of exhalation, and by a total abftinence from 
drink, dropfies have been entirely cured. 
What conclufion is to be drawn from thefe 
fa els is, however, very doubtful. A dropfy 
arifmg from a large quantity of liquids taken 
in to the body has been a very rare occurrence ; 
and there are, on the other hand, innumerable 
inflances of very large quantities of water hav- 
ing been taken in and running oil again very 
quickly by ftool and urine, without produc- 
ing any degree of dropfy. With refpeel to 
the total abftinence from drink, it is a practice 
of the molt difficult execution ; and therefore 
has been fo feldom pra&ifed, that we cannot 

pofiibly 



OF PH.YSIC. 289 



• 



pollibly know how far it might prove effe&u- 
;il. The practice of giving drink very fpar- 
mgly has indeed been often employed : But 
in a hundred inftances, I have feen it car- 
ried to a great length without any manifefl 
advantage : while, on the contrary, the prac- 
tice of giving drink very largely has been 
found not only fafe, but very often effectual 
in curing the difeafe. The ingenious and 
learned Dr. Millman has, in my opinion, been 
commendably employed in reftoring the prac- 
tice of giving large quantities of watery liquors 
for the cure of dropfy. Not only from the 
inftances he mentions from his own practice, 
and from that of feveral eminent phyficians 
in other parts of Europe, but alfo from many 
inftances in the records of phyfic, of the good 
effects of drinking large quantities of mineral 
waters in the cure of droplv, I can have no 
doubt of the practice recommended by Dr. 
Millman being very often extremely proper. 
I apprehend it to be efpecially adapted to 
thole cafes in which the cure is chiefly at- 
tempted by diuretics. It is very probable, 
that thefe medicines can hardly be carried in 
any quantity to the kidneys without being ac- 
companied with a large portion of water ; and 
the late frequent employment of the cryftals 
of tartar has often mown, that the diuretic 
effects of that medicine are almoft only re- 
markable when accompanied with a large 
quantity of water ; and that without this, the 
diuretic effects of the medicine feldom ap- 
pear. 



2 9 o PRACTICE 

pear. I fliall conclude this fubjecl with ob~ 
ierving, that as there are i'o many cafes of 
dropfy abfolutely incurable, the practice now 
under confideration may often fail, yet in 
moil cafes it may be laiely tried ; and if it 
appear that the wau r taken in paifes readily 
by the urinary fecretion, and eipeciaHy that 
it increafes the urine b:yond the quantity of 
drink taken in, the praciice may p >bab:y be 
continued with great advantage : But, on the 
contrary, if the urine be not mcreafed, or be 
not even in proportion to the drink taken in, 
it may be concluded, that the water thrown 
in runs ofF by the exhalants, and will augment 
the difeafe. 

MDCLXXXVI. 

Another fet of remedies which may be em- 
ployed for exciting a ferous excretion, and 
thereby curing dropfy, is that of fudorifics. 
Such remedies, indeed, have been fometimes 
employed : But however ufeful they may 
have been thought, there are few accounts of 
their having effe&ed a cure ; and although I 
have had fome examples of their fuccefs, in 
moft inftances of their trial they have been 
ineffectual. 

Upon this fubjecl; it is proper to take notice 
of the feveral means that have, been propofed 
and employed for diffipating the humidity of 
the body ; and particularly that of heat ex- 
ternally applied to the furface of it. Of fuch 

applications 



OF PHYSIC. 291 

applications I have had no experience ; and 
their propriety and utility mull reft upon the 
credit or the authors who relate them. I 
mail offer only this conjecture upon the fub- 
jefcr. : That if fuch meafures have been truly 
ufefu), as it has feldom been by the drawing 
out of any ienfible humidity, it has probably 
been by their reftoring the perfpiration, which 
is fo often greatly diminifhed in this difeafe ; 
or, perhaps, by changing the flate of the fkin, 
from the imbibing condition which is alleged 
to take place, into that of perfpiring. 

MDCLXXXVII. 

When, by the feveral means now men- 
tioned, we mail have fucceeded in evacuating 
the water of dropfies, there will then efpecial- 
]y be occafion for our third indication ; which 
is, to reftore the tone of the fyftem, the lofs 
of which is fo often the caufe of the difeafe. 
This indication, indeed, may properly have 
place from the very firft appearance of the 
difeafe ; and certain meafures adapted to this 
purpofe may, upon fuch firft appearance, be 
employed with advantage. In many cafes of 
a moderate difeafe, I am perfuaded that they 
may obviate any future increafe of it. 

MDCLXXXVIII. 

Thus, upon what is commonly the firft 
fymptom of anafarca, that is, upon the ap- 
pearance 



292 P R A C T I C E 

pearance of what are called Oedematous 
Swellings of the feet and legs, the three rem- 
edies of bandaging, friction, and exercife, 
have often been ufed with advantage. 

MDCLXXXIX. 

That fome degree of external compreflion 
is fuited to fupport the tone of the veffels, and 
particularly to prevent the effects of the 
weight of the blood in dilating thofe of the 
lower extremities, muft be fufficiently evident ; 
and the giving that eompreflion by a bandage 
properly applied, has been often ufeful. In 
applying fuch a bandage, care is to be taken 
that the eompreflion may never be greater on 
the upper than on the lower part of the limb ; 
and this, I think, can hardly ever be fo cer- 
tainly avoided, as by employing a properly 
conftructed laced flocking. 

MDCXC. 

Friction is another means by 'which the ac- 
tion of the bloodveffels may be promoted, and 
thereby the ftagnation of fluids in their ex- 
tremities prevented. Accordingly, the ufe of 
the flefh brum has often contributed to dif- 
cufs cedematous fwellings. It appears to me, 
that friction, for the purpofes now mention- 
ed, is more properly employed in the morn- 
ing, when the fwelling is very much gone off, 
than in the evening, when any confiderable 

degree 






OF PHYSIC. »93 

degree of it has already come on. I appre- 
hend alfo, that friction being made from be- 
low upwards only, is more ufeful than when 
made alternately upwards and downwards. 
It has been common, inftead of employing 
the flefh brufh, to make the fridtion by warm 
and dry flannels ; and this may in Tome cafes 
be the mod convenient : But I cannot per- 
ceive that the impregnation of thefe flannels 
with certain dry fumes is of any benefit, 

MDCXCI. 

With refpect to exercife, I mud obferve, 
that although perfons being much in an ereel; 
pofture during the day, may feem to increafe 
the fwelling which comes on at night ; yet as 
the action of the mufcles has a great fhare in 
promoting the motion of the venous blood, fo 
I am certain, that as much exercife in walk- 
ing as the patient can eafily bear, will often 
prevent that cedematous fwelling which much 
Handing, and even fitting, would have brought 
on. 

MDCXCII. 

Thefe meafures, however, although they 
may be ufeful at the coming on of a dropfy, 
whofe caufes are not very powerful, will be 
often infufficient in a more violent difeafe ; 
and fuch therefore will require more powerful 
remedies. Thefe are, exercife and tonic 

medicines ; 



294 PRACTICE 

medicines ; which may be employed both 
during the courfe of the difeafe, and efpecial- 
\y after the water has been evacuated. 



MDCXCIII. 



Exercife is fuited to afiift in every function 
of the animal economy, particularly to pro- 
mote perfpiration, and thereby prevent the 
accumulation of watery fluids in the body. 
I apprehend alfo, that it may be the moll ef- 
fectual means for preventing the fkin from 
being in an imbibing ftate ; and, as has been 
hinted above on the fubiec"f. of Emaciation 
(M DC VI I), I am perfuaded, that a full and 
large perfpiration will always be a means of 
exciting abforption in every part of the fyf- 
tem. Exercife, therefore, promifes to be 
highly ufeful in dropfy ; and any mode of it 
may be employed that the patient can mod 
conveniently admit of. It mould, however, 
always be as much as he can eafily bear ; and 
in anafarca, the fhare which the exercife of 
mufcles has in promoting the motion of the 
venous blood, induces me to think that bodi- 
ly exercife, to whatever degree the patient 
can bear it, will always be the moft ufeful. 
From fome experience alfo, lam perfuaded, 
that by exercife alone, employed early in ths 
tfifeafe, many dropfies may be cured. 

MDCXCIV. 



OF PHYSIC. 295 

MDCXCIV. 

Befides exercife, various tonic remedies are 
properly employed to reftore the tone of the 
fyflem. The chief of thefe are, chalybeates, 
the Peruvian bark, and various bitters. 
Thefe are not only fuited to reftore the tone 
of the fyflem in general, but are particularly 
ufeful in ftrengthening the organs of digef- 
tion, which in dropfies are frequently very 
much weakened : And for the fame purpofe 
alfo aromatics may be frequently joined with 
the tonics. 

MDCXCV. 

Cold bathing is upon many occafions the 
molt powerful tonic we can employ ; but at 
the beginning of dropfy, when the debility of 
the fyflem is confiderable, it can hardly be 
attempted with fafety. After, however, the 
water of dropfies has been very fully evacu- 
ated, and the indication is to ftrengthen the 
fyflem for preventing a relapfe, cold bathing 
may perhaps have a place. It is, at the fame 
time, to be admitted with caution ; and can 
fcarcely be employed till the fyflem has oth- 
erwife recovered a good deal of vigour. 
When that indeed has happened, cold bath- 
ing may be very ufeful in confirming and 
completing it. 

MDCXCVI. 



296 PRACTICE 

MDCXCVI. 

In per Tons recovering from dropfv, while 
the feveral means now mentioned for llrength- 
ening the fyftem are employed, it will be 
proper at the fame time to keep conftantly in 
view the fupport of the watery excretions ; 
and confequently the keeping up the perfpi- 
ration by a great deal of exercife, and contin- 
uing the full flow of the urinary excretioas 
by the frequent ufe of diuretics. 



t. II. 



O/ik Hydrothorax, or Dropsy of the 
Breast. 



MDCXCVII. 

THE preternatural collection of ferous 
fluid in the thorax, to which we give the ap- 
pellation of Hydrothorax, occurs more fre- 
quently than has been imagined. Its pres- 
ence, however, is not always to be very cer- 
tainly known ; and it often takes place to a 
confiderable degree before it be difcovered. 

mdcxcvii:. 



OF PHYSIC. 297 



MDCXCVIII. 

Thefe collections of watery fluids in the 
thorax, are found in different fituations. 
Very often the water is found at the fame 
time in both facs of the pleura, but frequent- 
ly in one of them only. Sometimes it is 
found in the pericardium alone ; but for the 
molt part it only appears there when at the 
fame time a collection is prefent in one or 
both cavities of the thorax. In fome inftances, 
the collection is found to be only in that cel- 
lular texture of the lungs which furrounds 
the bronchiae, without there being at the 
fame time any effufion into the cavity of the 
thorax* 

Pretty frequently the water collected con- 
fills chiefly of a great number of hy da tides 
in different fituations ; fometimes feemingly 
floating in the cavity, but frequently con- 
nected with and attached to particular parts 
of the internal furface of the pleura. 

MDCXCIX. 

From the collection of water being thus in 
various fituations and circumftances, fymp- 
toms arife which are different in different 
cafes ; and from thence it becomes often dif- 
ficult to afcertaih the prefence and nature of 
the affection. I ftiall, however, endeavour 
here to point out the mofl common fymp- 

toms, 



298 PRACTICE 

toms, and efpecially thofe of that principal 
and mofl frequent form of the difeafe, when 
the ferous fluid is prefent in both facs of the 
pleura, or, as we ufually fpeak, in both cav- 
ities of the thorax. 

MDCC. 

The difeafe frequently comes on with a 
fenfe of anxiety about the lower part of the 
fternum. This, before it has fubfifted long, 
comes to be joined with fome difficulty of 
breathing ; which at firft appears only upon 
the perfon's moving a little fafter than ufual, 
upon his walking up an acclivity, or upon his 
afcending a ftaircafe : But after fome time, 
this difficulty of breathing becomes more con- 
ftant and confiderable, efpecially during the 
night, when the body is in a horizontal fitua- 
tion. Commonly, at the fame time, lying 
upon one fide is more eafy than upon the 
other, or perhaps lying upon the back more 
eafy than upon either fide. Thefe circum- 
flances are ufually attended with a frequent 
cough, that is at firft dry ; but which, after 
fome time, is accompanied with an expecto- 
ration of thin mucus. 

With all thefe fymptoms, the hydrothorax 
is not certainly difcovered, as the fame fymp- 
toms often attend other difeafes of the breaft. 
When, however, along with thefe fymptoms, 
there is at the fame time an cedematous fwell- 
jng of the feet and legs, a leucophlegmatic 

palenefs 



OF PHYSIC. 299 

palenefs of the face, and a fcarcity of urine, 
the exiflence of a hydrothorax ca 1 be no 
longer doubtful. Some writers have told us, 
that fometimes in this difcafe, before the fwell- 
ing of the feet comes on, a watery fwelling of 
the fcrotum appears ; but I have never met 
with any inflance of this. 

MDCCI. 

Whilft the prefence of the difeafe is fome- 
what uncertain, there is a fymptom which 
fometimes takes place, and has been thought 
to be a certain characteristic of it ; and that 
is, when, foon after the patient has fallen 
afleep, he is fuddenly awaked with a fenfe of 
anxiety and difficult breathing, and with a 
violent palpitation of the heart. Thefe feel- 
ings immediately require an ereft pofture ; 
and very often the difficulty of breathing con- 
tinues to require and to prevent fleep for a 
great part of the night. This fymptom I 
have frequently found attending the difeafe ; 
but I have alfo met with feveral inltances in 
which this fymptom did not appear. I muft 
remark further, that I have not found this 
fymptom attending the empyema, or any oth- 
er difeafe of the thorax ; and therefore, when 
it attends a difficulty of breathing, accompa- 
nied with any the fmalleft fymptom of drop- 
fy t I have had no doubt in concluding the 
prefence of water in the cheft, and have al- 
ways 



3 00 PRACTICE 

ways had my judgment confirmed by the 
fymptoms which afterwards appeared. 

MDCCII. 

The hydrothorax often Occurs with very 
ftw t or almoft none, of the fymptoms above 
mentioned ; and is not, therefore, very cer- 
tainly difcovered till fome others appear. 
The mod decifive fymptom is a fluctuation 
of water in the cheft, perceived by the patient 
himfelf, or by the phyfician, upon certain 
motions of the body. How far the method 
propofed by Auenbrugger will apply to af- 
certain the prefence of Water and the quantity 
of it in the cheft, I have not had occafion or 
opportunity to obferve. 

It has been faid, that in this difeafe fome 
tumour appears upon the fides or upon the 
back ; but I have not met with any inftance 
of this. In one inflance of the difeafe, I 
found one fide of the thorax confiderably en- 
larged, the ribs Handing out farther on that 
fide than upon the other. 

A numbnefs and a degree of palfy in one 
or both arms, has been frequently obferved to 
attend a hydrothorax. 

Soon after this difeafe has made fome prog- 
refs, the pulfe commonly becomes irregular, 
and frequently intermitting : But this hap- 
pens in fo many other difeafes of the breaft, 
that unlefs when it is attended with fome 

other 



kj r r ii i a i v^. 301 

other of the above mentioned fy mptoms it 
cannot be confidered as denoting the hydro- 
thorax. 

MDCCIII. 

This difeafe, as other dropOes, is commonly 
attended with thirft and a fcarcity of urine, 
to be explained in the fame maimer as in the 
cafe of anafarca (MDCLXXIII). The hy- 
drothorax, however, is fometimes without 
thirft, or any other febrile fymptom ; al- 
though I believe this happens in the cafe of 
partial affections only, or when a more gen- 
eral affettion is yet but in a flight degree. 
In both cafes, however, and more efpecially 
when the difeafe is confiderably advanced, 
fome degree of fever is generally prefent : 
And I apprehend k to be in fuch cafe, that 
the perfons affected are more than ufually 
fenfible to cold, and complain of the coldnefs 
of the air when that is not perceived by oth- 
er perfons. 

MDCCIV. 

The hydrothorax fometimes appears alone, 
"without any other fpecies of dropfy being 
prefent at the fame time : And in this cafe 
the difeafe, for the molt part, is a partial af- 
fection, as being either of one fide of the 
thorax only, or being a collection of hydatides 
in one part of the chefl. The hydrothorax, 

Vol. III. O however, 



302 PRACTICE 

however, is very often a part of more univer- 
fal dropfy, and when at the fame time there 
is water in all the three principal cavities and 
in the cellular texture of a great part of the 
bodv. I have met with feveral inftances, in 
which fuch univerfal dropfy began firft by an 
effufion into the thorax. The hydrothorax, 
however, more frequently comes on from an 
anafarca gradually increafing ; and, as I have 
(aid above, the general diathefis feems often 
to affect the thorax fooner than it does either 
the head or the abdomen. 

MDCCV. 

This difeafe feldo'm admits of a cure, or 
«ven of alleviation, from remedies. It com- 
monly proceeds to give more and more diffi- 
culty of breathing, till the attion of the lungs 
be entirely interrupted by the quantity of 
water effufed j and the fatal event frequently 
happens more fuddenly than was expected. 
In many of the inftances of a fatal hydrotho- 
rax, I have remarked a fpitting of blood to 
come on feveral days before the patient died. 

MDCCVI. 

The caufe of hydrothorax is often manu 
feflly one or other of the general caufes of 
dropfy pointed out above : But what it is 
that determines thefe general caufes to aft 
tnore efpecially in the thorax, and particular^. 






U £ PHYSIC 303 

]y what it is that produces the partial collec- 
tions that occur there, I do not find to be ea- 
fily iifcertained. 

MDCCVII. 

From what has been faid above, it will be 
evident, that the cure of hydrothorax muft 
be very much the fame with that of anafarca j 
and when the former is joined with the latter 
as an effect of the fame general diathefis, there 
can be no doubt of the method of cure being 
the fame in both. Even when the hydrotho- 
rax is alone, and the difeafe partial, from par- 
ticular caufes a6ling in the thorax only, there 
can hardly be any other meafures employed, 
than the general ones propofed above. There 
is only one particular meafure adapted to the 
hydrothorax ; and that is, the drawing off the 
accumulated waters by a paracentefis of the 
thorax. 

MDCCVIII. 

To what cafes this operation may be moffc 
properly adapted, I find it difficult to deter- 
mine. That it may be executed with fafiety> 
•there is no doubt ; and that it has been forne- 
times pra£lifed with fuccefs, feems to be very 
well vouched. When the difeafe depends 
upon a general hydropic diathefis, it cannot 
alone prove a cure, but may give a temporary 
relief ; and when other remedies feem to be 
O 2 employed 



3 04 PRACTICE 

employed with advantage, the drawing off 
the water may very much favour a complete 
cure. I havo not, however, been fo fortu- 
nate as to fee it practifed with any fuccefs ; and 
even where it was moll promifing, that is, in 
cafes of partial affection, my expectations have 
been difappointed from it. 



III. 



■Of Ascites, or Dropsy of the Lower 
Belly. 



MDCCIX \ 

THE name of A/cites is given to every col- 
lection of waters caufmg a general fwelling 
and diftention of the lower belly ; and fuch 
collections are more frequent than thofe 
Ivhich happen in the thorax. 

MDCCX. 

The collections in the lower belly, like thofe 
of the thorax, are found in different fitua- 
tions. Mod commonly they are in the fac of 
the peritoneum, or general cavity of the ab- 
domen : But they often begin by lacs formed 
upon, and connected with, one or other ot 
the vifcera ; and perhaps the mod frequeat 

inftanccs 



OF PHYSIC. 305 

inftances of this kind occur in the ovaria of 
females. Sometimes the water of afcites is 
found entirely without the peritonaeum, and 
between this and the abdominal mufcles. 

MDCCXI. 

Thefe collections connected with particular 
vifcera, and thofe formed without the perito- 
naeum, form that difeafe which authors hive 
termed the encyjled dropfy, or hydrops face 
Their precife feat, and even their exHtence, 
is very often difficult to be afcertained. They 
are generally formed by collections of liy- 
datides. 

MDCCXII. 

In the moll ordinary cafe, that of abdom- 
inal dropfv, the fwelling at firft is in fome 
meafure over the whole belly, but generally 
appears mod confiderable in the epigaftrium. 
As- the difeafe, however, advances, the fwell- 
ing becomes more uniform over the whole. 
The dillention, and fenfe of weight, though 
confiderable, vary a little according as the 
pofture of the body is changed ; the weight 
being felt the moft upon the fide on which 
the patient lies, while at the fame time on the 
oppofite fide the dillention becomes fome- 
what lefs. In almoft all the inftances of af- 
cites, the fluctuation of the water within, mav 
be perceived by the practitioner's feeling, and 
O 3 fometimes 



306 PRACTICE 

fometimes by his hearing. This perception 
of fluctuation does not certainly diflinguifli 
the different ftates of dropfy ; but ferves very 
well to diftinguifh dropfy from tympanites, 
from cafes of phyfconia, and from the Itate of 
pregnancy in women. 

MDCCXIII. 

An afcites frequently occurs when no other 
fpecies of dropfy does at the fame time ap- 
pear ; but fometimes the afcites is a part only 
of univerfal dropfy. In this cafe, it ufually 
comes on in confequence of an anafarca, grad- 
ually increafmg ; but its being joined with 
anafarca, does not always denote any general 
diathefis, as for the moil part an afcites foon- 
er or later occafions oedematous fwellings of 
the lower extremities. When the collection 
©f water in the abdomen, from whatever 
caufe, becomes confiderable, it is always at- 
tended with a difficulty of breathing : But 
this fymptom occurs often when, at the fame 
time, there is no water in the thorax. The 
afcites is fometimes unaccompanied with any 
fever ; but frequently there is more or lefs of 
fever prefent with it. The difeafe is never 
confiderable, without being attended with 
thirft and a fcarcity of urine. 

MDCCXIV. 

In the diagnofis of afcites, the greateft. dif- 
ficulty that occurs, is in difcerning when the 

water 



OF PHYSIC. 307 

water is in the cavity of the abdomen, or when 
it u in the different dates of encyfted dropfy 
above mentioned. There is, perhaps, no cer- 
tain^means of ascertaining this in all cafes ; 
but lVmany we may attempt to form fome 
judgment with regard to it. 

When the antecedent circumftances give 
fufpicion of a general hydropic diathefis ; 
when at the fame time fome degree of dropiy 
appears in other parts of the body ; and when, 
from its firft appearance, the fweiling has been 
equally over the whole belly, we may gen- 
erally prefume that the water is in the cavity 
of the' abdomen. But when an afcites has 
not been preceded by any remarkably cachec- 
tic ftate of the fyftem, and when at its begin- 
ning the tumour and tenfion had appeared in 
one part of the belly more than another, there 
is reafon to fufpeft an encyfted dropfy. Even 
when the tenfion and tumour of the belly 
have become general and uniform over the 
whole ; yet if the fyftem of the body in gen- 
eral appear to be little affecled ; if the pa- 
tient's ftrength be little impaired ; if the ap- 
petite continue pretty entire, and the natural 
fieep be. little interrupted ; if the menfes in 
females continue to flow as ufual ; if there be 
yet no anafarca ; or, though it may have al- 
ready taken place, if it be ftill confined to the 
lower extremities, and there be no leucophlcg- 
matic-palenefs or fallow colour in the counte- 
nance ; if there be no fever, nor fo much 
thirft, or fcarcity of urine, as occur in a 
'O 4 more 



308 PRACTICE 

more general affe&ion ; then, according as 
more of thefe different circumftances take 
place, there will be the ftronger ground for 
iuppofmg the afcites la be of the encyfted 
kind. 

The chief exception to be made from this 
as a general rule, will, in my opinion, be when 
the afcites may, with much probability, be 
prefumed to have come on in confequence of 
a fcirrhous liver ; which, I apprehend, may 
occafion a collection of water in the cavity of 
the abdomen, while the general fyftem of the 
body may not be otherwife much affecled. 



MDCCXV. 



With refpect to the cure of afcites when of 
the encyfted kind, it does not, fo far as I know, 
admit of any. When the collection of water 
is in the abdominal cavity alone, without any 
other fpecies of dropfy prefent at the fame 
time, I apprehend the afcites will always be 
of difficult cure ; for it may be prefumed to 
depend upon a fcirrhofiry of the liver, or oth- 
er confiderable affe&ion of the abdominal vif- 
cera, which I conceive to be of very difficult 
cure, and therefore the afcites depending up- 
on them. At the fame time, fuch cafes may 
often admit of a. temporary relief by the par- 
acentesis. 

MDCCXVI, 



OF PHYSIC. 309 



MDCCXVI. 

When the afcites is a part of univerfal rlrop- 
fy, it may, as far as other cafes of that kind 
can, admit of a cure ; and it will be obviou^yj 
that fuch a cure muft be obtained by the fame 
means as above propofed for the cure of gen- 
eral anafarca. 

It frequently happens, that the afcites is at- 
tended with a diarrhoea ; and, in that cafe, 
does not admit of the ufe of purgatives fo 
freely as cafes of anafarca commonly do. It 
is therefore often to be treated by diuretics 
almoft alone. 

The diuretics that may be employed, are 
chiefly thofe above mentioned ; but in afcitesi 
a peculiar one has been found out. It is a 
long continued gentle fri&ion of the fkin over 
the whole of the abdomen, by the fingers 
dipped in oil. This has fometimes been ufe- 
ful in exciting an increafed flow of urine ; but 
in mod of the trials of it which I have known 
made, it has failed in producing that effect. 

MDCCXVII. 

The afcites admits of a particular means 
for immediately drawing off the collected 
waters ; and that is the well known operation 
of the paracentefis of the abdomen. In what 
circumftances of afcites this operation can 
mod properly be propofed, it is difficult to 

Vol. 3. O5 determine; 



3io PRACTICE 

determine ; but, fo far as I can judge, it muft 
be regulated by very much the fame confid- 
crations as thofe above mentioned with regard 
to the paracentefis of the thorax. 

The manner of performing the paracentefis 
of the abdomen, and the precautions to be 
taken with refpeel; to it, are now fo commonly 
known, and delivered in fo many books, that 
it is altogether unneceffary for me to offer any 
directions upon that fubje6t, here ; efpecially 
after the full and judicious information and 
directions given by Mr. Bell, in the fecond 
volume of his Syjlcm of Surgery. 



CHAP. 



OF PHYSIC. 311 



CHAP. IV. 



of GENERAL SWELLINGS, arising 

FROM AN INCREASED BULK OF THE 

whole SUBSTANCE of particular 
PARTS. 



MDCCXVIII. 

UPON the fubjecls of this 
chapter, feveral nofological difficulties occur, 
and particularly with re ("peel; to admitting the 
Phyfconia into the order of General Swellings. 
At prefent, however, it is not neceffary for 
me to difcufs this point, as I am here to omit 
entirely the confideration of Phyfconia ; both 
becaufe it can feldom admit of any fuccefsful 
pra&ice, and becaufe I cannot deliver any 
thing ufeful either with regard to the patholo- 
gy or practice in fuch a difeafe. 

MDCCXIX. 

The only other genus of difeafe compre- 
hended under the title of the prefent chapter, 
is the Rachitis ; and this being both a proper 
example of the clafs of Cachexy, and of the 
O 6 order 



gt2 PRACTICE 

order of Intumef unties or General Swellings, 
I (hall offer fome obfervations with regard 
to it. 

Of Rachitis, or Rickets. 

MDCCXX. 

THIS difeafe has been fuppofed to have 
appeared only in modern times, and not above 
two hundred years ago. This opinion, not- 
withstanding it has been maintained by per- 
fons of the moft refpe&able authority, ap- 
pears to me, from many considerations, im- 
probable ; but it is a point of too little confe- 
quence to detain my readers here. The only 
application of it which deferves any notice is, 
that it has ltd to a notion of the difeafe having 
arifen from the lues venerea, which had cer- 
tainly made its firft appearance in Europe 
not very long before the date commonly af- 
figned for the appearance of rachitis : But I 
fhall hereafter mow, that the fuppofed con- 
nexion between the Siphylis and Rachitis is 
without foundation. 

MDCCXXI. 

In delivering the hiftory of the Rickets, I 
muft, in the firfb place, obferve, that with ref- 
pec~t to the antecedents of the difeafe, every 
thing to be found in authors upon this fub- 
ject, appears to me to reft upon a very un- 
certain 



OF PHYSIC. 313 

certain foundation. In particular, with ref- 
pecl; to the Hate of the parents whofe offspring 
become affe&ed with this difeafe, I have met 
with many inftances of it, in children from 
feemingly healthy parents ; and have met 
likewife with many inftances of children who 
never became affected with it, although bom 
of parents who, according to the common ac- 
counts, mould have produced a rickety oftv 
lpring : So that, even making allowance for 
the uncertainty of fathers, I do not find the 
general opinion of authors upon this fubjeft 
to be properly fupported. 

MDCCXXII. 

The difeafe, however, may be juftly con- 
fidered as proceeding from parents ; for it 
often appears in a great number of the fame 
family : And my observation leads me to 
judge, that it originates more frequently from 
mothers than from fathers. So far as I can 
refer the difeafe of the children to the ftate of 
the parents, it has appeared to me moft com- 
monly to arife from fome weaknefs, and pretty 
frequently from a fcrophulous habit, in the 
mother. To conclude the fubjecl:, I rauft re- 
mark, that in many cafes I have not been able 
to difcern the condition of the parents, to 
which I could refer it. 

When nurfes, other than the mothers, have 
been employed to fuckle children, it has been 
fuppofed that fuch nurfes have frequently 

given 



3 i4 PRACTICE 

given occaiion to the difeafe : And when 
nurfes have both produced and have lucklecj 
children who became rickety, there may be 
ground to fufpe£t their having occafioned the 
difeafe in the children of other perfons : But 
I have had few opportunities of afcertaining 
this matter. It has in fome meafure appear- 
ed to me, that thole nurfes are moll likely to 
produce this difeafe, who give infants a large 
quantity of very watery milk, and who con- 
tinue to fuckle them longer than the ufual 
time. Upon the whole, however, I am of 
opinion, that hired nurfes feldom occafion 
this difeafe, unlefs when a predifpofition to 
it has proceeded from the parents. 

MDCCXXIII. 

With regard to the other antecedents, which 
have been ufually enumerated by authors as 
the remote caufes of this difeafe, I judge the 
accounts given to be extremely fallacious ; 
and I am very much perfuaded, that the cir- 
cumftances in the rearing of children, have 
lefs effect in producing rickets than has been 
imagined. It is indeed not unlikely, that 
fome of thefe circumftances mentioned as re- 
mote caufes may favour, while other circum- 
ftances may refill, the coming on of the dif- 
eafe ; but at the fame time, I doubt if any of 
the former would produce it where there was 
no predifpofition in the child's original con- 
ftitution. This opinion of the remote caufes, 

I have 



OF PHYSIC. 315 

I have formed from obferving, that the dif- 
eafe comes on when none of thefe had been 
applied ; and more frequently that many of 
them had been applied without occafioning 
the difeafe. Thus the learned Zeviani al- 
leges, that the difeafe is produced by an acid 
from the milk with which a child is fed for 
the firft nine months of its life : But almoft 
all children are fed with the fame food, and in 
which alio an acid is always produced ; while, 
at the fame time, not one in a thoufand of the 
infants fo fed becomes affe&ed with the rick- 
ets. If, therefore, in the infants who become 
affe&ed with this difeafe, a peculiarly noxious 
acid is produced, we mult feek for fome pe- 
culiar caufe of its production, either in the 
quality of the milk, or in the conftitution of 
the child ; neither of which, however, Mr. 
Zeviani has explained. I cannot indeed be- 
lieve that the ordinary acid of milk has any 
flhare in producing this difeafe, becaufe I 
have known many inftances of the acid being 
produced and occafioning various diforders, 
without, however, its ever producing rickets. 
Another of the remote caufes commonly 
affigned, is the child's being fed with unfer- 
mented farinaceous food. But over the whole 
world children are fed with fuch farinacea, 
while the difeafe of rickets is a rare occur- 
rence : And I have known many inftances 
where children have been fed with' a greater 
than ufual proportion of fermented farinacea, 
and alfo a greater proportion of animal food, 

without 



3 i6 PRACTICE 

without thefe preventing the difeafe. In my 
apprehenfion, the like obfervations might be 
made with refpefl: to moft of the circum- 
ftances that have been mentioned as the re- 
mote caufes of rickets. 

MDCCXXIV. 

Having thus offered my opinion concern- 
ing the fuppofed antecedents of this difeafe, I 
proceed now to mention the phenomena oc- 
curring after it has aclually come on. 

The difeafe feidom appears before the 
ninth month, and feidom begins after the 
fecond year, of a child's age. In the interval 
between thefe periods, the appearance of the 
difeafe is fometimes fooner, fometimes later ; 
and commonly at firfl the difeafe comes on 
flowly. The firfl appearances are a flaccidity 
of the flefh, the body at the fame time becom- 
ing leaner, though food be taken in pretty 
largely. The head appears large with refpecl; 
to the body ; with the fontanelle, and per- 
haps the futures, more open than ufual in 
children of the fame age. The head contin- 
ues to grow larger ; in particular, the fore- 
head becoming unufually prominent ; and at 
the fame time the neck continues (lender, or 
feems to be more ^o t in proportion to the 
head. The dentition is flow, or much later 
than ufual ; and thofe teeth which come out, 
readily become black, and frequently again 
fall out. The ribs lofe their convexity, and 

become 



OF PHYSIC. 3*7 

become flattened on the fides ; while the fler- 
num is pufhed outward, and forms a fort of 
ridge. At the fame time, or perhaps fooner, 
the epiphyfes at the feveral joints of the 
limbs become fwelled ; while the limbs be- 
tween the joints appear, or perhaps actually 
become, more llender. The bones feem to 
be every where flexible, becoming varioufly 
diftorted ; and particularly the fpine of the 
back becoming incurvated in different parts 
of its length. If the child, at the time the 
difeafe comes on, had acquired the power 
of walking, it becomes daily more feeble in 
its motions, and more averfe to the exertion 
of them, lofing at length the power of walk- 
ing altogether. Whilft thefe fymptoms go 
on increafmg, the abdomen is always full, and 
preternaturally tumid. The appetite is often 
good, but the ftools are generally frequent 
and loofe. Sometimes the faculties of the 
mind are impaired, and flupidity or fatuity 
prevails ; but commonly a premature fenfi- 
bility appears, and they acquire the faculty 
of fpeech fooner than ufual. At the firlt 
coming on of the difeafe, there is generally no 
> fever attending it; but it feldom continues 
long, till a frequent pulfe, and other febrile 
fymptoms, come to be conftantly prefent. 
With thefe fymptoms the difeafe proceeds, and 
continues in fome inflances for fome years ; 
but very often, in the courfe of that time, the 
difeafe ceafes to advance, and the health is 
entirely eftablifhed, except that the diftorted 

limbs 



318 PRACTICE 

limbs produced during the difeafe continue 
for the reft of life. In other cafes, however, 
the difeafe proceeds increafing till it has af- 
fefted almoft every function of the animal 
economy, and at length terminates in death. 
The variety of fymptoms wfyich in fiich cafes 
appear, it does not feem neceffary to enume- 
rate, as they are not effential to the conflitu- 
tion of the difeafe, but are merely confe- 
quences of the more violent conditions of it. 
In the bodies of thofe who have died, various 
morbid affections have been difcovered in the 
internal parts. Moil of the vifcera of the 
abdomen have been found to be preternatur- 
ally enlarged. The lungs have alfo been 
found in a morbid ftate, feemingly from fome 
inflammation that had come on towards the 
end of the difeafe. The brain has been com- 
monly found in a flaccid ftate, with effufions 
of a ferous fluid into its cavities. Very uni- 
verfaliy the bones have been found very foft, 
and fo much foftened as to be readily cut by 
a knife. The fluids have been always found 
in a diffolved ftate, and the mufcular parts 
very foft and tender ; and the whole of the 
dead body without any degree of that rigidity 
which is fo common in almoft all others. 

MDCCXXV. 

From thefe circumftances of the difeafe, it 
feems to confift in a deficiency of that matter 
which mould form the folid parts of the body. 

This 



OF PHYSIC. 319 

This efpecially appears in the faulty ftate of 
oflification,feemingly depending upon the de- 
ficiency of that matter which fhould be depos- 
ited in the membranes which are deftined to 
become bony, and mould give them their due 
firtnnefe and bony hardnefs. It appears that 
this ma-tter is not fupplied in due quantity ; 
but that in place of it, a matter fitted to in- 
creafe their bulk, particularly in the epiphy- 
fes, is applied too largely. What this defi- 
ciency of matter depends upon, is difficult to 
be afcertained. It may be a fault in the or- 
gans of digeftion and ailimilation, which pre- 
vents the fluids in general from being prop- 
erly prepared ; or it may be a fault in the or- 
gans of nutrition, which prevents the fecretion 
of a proper matter to be applied. With rei- 
pecl: to the latter, in what it may confift, I 
am entirely ignorant, and cannot even difcern 
that fuch a condition exifts : But the former 
caufe, both in its nature and exiftence, is 
more readily perceived ; and it is probable 
that it has a considerable influence in the 
matter ; as in rachitic perfons a thinner ftate 
of the blood, both during life and after death, 
fo commonly appears. It is this ftate of the 
fluids, or a deficiency of bony matter in them, 
that I confider as the proximate caufe of the 
difeafe ; and which again may in fome meai- 
ure depend upon a general laxity and de- 
bility of the moving fibres of the organs that 
perform the functions of digeftion and affim- 
ilation. 

MDCCXXVI. 



320 PRACTICE 

MDCCXXVI. 

There is, however, fomething IT ill wanting 
to explain, Why thei'e circumftances difcover 
themfelves at a particular time of life, and 
hardly ever either before or after a certain 
period ; and as to this I would offer the fol- 
lowing conjectures. Nature having intended 
that human life mould proceed in a certain 
manner, and that certain functions mould be 
exercifedat a certain period of life only ; fo 
it has generally provided, that at that period, 
and not fooner, the body mould be fitted for 
the exercife of the functions fuited to it. To 
apply this to our prefent fubject, Nature 
feems to have intended that children mould 
walk only at twelve months old ; and accord- 
ingly has provided, that againft that age, and 
no fooner, a matter mould be prepared fit to 
give that firmnefs to the bones which is necef- 
fary to prevent their bending too eafily under 
the weight of the body. Nature, however, 
is not always fteady and exact in executing 
her own purpofes ; and if therefore the prep- 
aration of bony matter fhall not have been 
made againft the time there is particular oc- 
cafion for it, the difeafe of rickets, that is, of 
foft and flexible bones, muft come on ; and 
will difcover itfelf about the particular period 
we have mentioned. Further, it will be 
equally probable, that if at the period men- 
tioned the bones fhall have acquired their 

due 



OF PHYSIC. 321 

due firmnefs, and that nature goes on in pr^ 
paring and Supplying the proper bony matter, 
it may he prefumed, that againfl the time a 
child is two years old* fuch a quantity of bony 
matter will be applied, as to prevent the bones 
from becoming again foft and flexible during 
the reft of life ; unlefs it happen, as indeed it 
fometimes does, that certain caufes occur to 
wafh out again the bony matter from the 
membranes in which it had been depofited. 
The account I have now given of the period 
at which the rickets occur, feems to confirm 
the opinion of its proximate caufe being a 
deficiency of bony matter in the fluids of the 
body. 

MDCCXXVII. 

It has been frequently fuppofed, that a 
fiphylitic taint has a fhare in producing rick- 
ets j but fuch a fuppofition is altogether im- 
probable. If our opinion of the rickets hav- 
ing exifted in Europe before the fiphylis was 
brought into it, be well founded, it will then 
be certain that the difeafe may be occafioned 
without any fiphylitic acrimony having a 
fhare in fts production. But further, when 
a fiphylitic acrimony is transmitted from the 
parent to the offspring, the fymptoms do not 
appear at a particular time of life only, and 
commonly more early than the period of rick- 
ets ; the fymptoms alfo are very different 
from thofe of rickets, and unaccompanied 

with 



322 PRACTICE 

with any appearance of the latter ; and, laftly, 
the fymptoms of fiphylis are cured by means 
which, in the cafe of rickets, have cither no 
effeel:, or a bad one. It may indeed pofiibly 
happen, that fiphylis and rickets may appear 
in the fame perfon ; but it is to be confidered 
as an accidental complication : And the very 
few inftances of it that have occurred, are by 
no means fufficient to eftablifh any necelfary 
connexion between the two difeafes. 



MDCCXXVIII. 

With refpecl: to the deficiency of bony 
matter, which I confider as the proximate 
caufe of rickets, fome further conjectures 
might be offered concerning its remote cauf- 
es : But none of them appear io me very fat- 
isfying ; and whatever they might be, it ap- 
pears to me they muft again be refolved into 
the fuppofition of a general laxity and debil- 
ity of the fyftem. 

MDCCXXIX. 

It is upon this fuppofition almoft alone that 
the cure of rickets has entirely proceeded. 
The remedies have been fuch efpecially as 
were fuited to improve the tone of the fyftem 
in general, or of the ftomach in particular t 
And we know that the latter are not only 
fuited to improve the tone of the ftomach it- 

felf, 



OF PHYSIC. 3 2 3 

feif, but by that means to improve alfo the 
tone of the whole (yftem. 

MDCCXXX. 

Of tonic remedies, one of the moft prom- 
ifing feems to have been cold bathing ; and I 
have found it the moft powerful in preventing 
the difeafe. for a long time paft, it has been 
the practice in this country, with people of 
all ranks, to warn their children from the time 
of their birth with cold water ; and from the 
time that children are a month old, it has 
been the practice with people of better rank 
to have them dipped entirely in cold water^ 
every morning : And wherever this practice 
has been puriued, I have not met with any 
inftance of rickets. Amongil our common 
people, although they wafti their children 
with cold water only, yet they do not fo com- 
monly practice immerfion : And when a- 
mongft thefe I meet with inftances of rickets, 
I prefcribe cold bathing ; which accordingly 
has often checked the progrefs of the difeafe, 
and fometimes feems to have cured it en- 
tirely. 

MDCCXXXI. 

The remedy of Ens Veneris, recommended 
by Mr. Boyle, and fince his time very uni- 
Verfally employed, is to be confidered as en* 
tirely a tonic remedy. That or fome other 

preparation 



324 P R A C '1' I t f. 

preparation of iron I have almoft conflantly 
employed, though not indeed always with 
fuccefs. I have been perfuaded, that the ens 
veneris of Mr. Boyle, notwithftanding his 
giving it this appellation, was truly a prepa- 
ration of iron, and no other than what we now 
name the Flore s Martiales : But it appears, 
that both Benevoli and Buchner have em- 
ployed a preparation of copper ; and I am 
ready to believe it to be a more powerful to- 
nic than the preparations of iron. 

MDCCXXXII. 

Upon the fuppofition of tonic remedies 
being proper in this difeafe, I have endeav- 
oured to employ the Peruvian bark : But 
from the difficulty of ad mini fieri ng it to in- 
fants m any ufeful quantity, I have not been 
able to difcover its efficacy ; but I am very 
ready to believe the teftimony of De Haen 
upon this fubjeel:. 

MDCCXXXIII. 

Exercife, which is one of the moil power- 
ful tonics, has been properly recommended 
for the cure of rickets ; and as the exercife of 
geftation only can be employed, it mould al- 
ways be, with the child laid in a horizontal 
fituation ; as the carrying them, or moving 
them in any degree of an erecTr. pofture, is 
very apt to occafion fome diftortion. It is 

extremely 



OF PHYSIC. 325 

extremely probable, that, in this difeafe, fric- 
tion with dry flannels may be found an ufeful 
remedy. 

MDCCXXXIV. 

It is alfo fufficiently probable, that the a- 
voiding of moifture is not only advifeable, but 
may hkewife be of fervice in the cure of this 
difeafe. 

There is no doubt that a certain diet may 
Contribute to the fame end ; but what may 
be the moil eligible, I dare not determine. 
I have no doubt that leavened bread may be 
more proper than unfennented farinacea ; 
but I cannot find any reafon to believe that 
lirong beer can ever be a proper remedy. 

Practitioners have been divided in opinion 
concerning the ufe of milk in this difeafe. 
Zeviani, perhaps from theory, condemns the 
u(e of it; but Benevoli employed it without 
its impeding the cure of the difeafe. This 
lafl; I have often remarked in the courfe of 
my own practice. As it is difficult to feed 
children entirely without milk ; fo I have 
commonly admitted it as a part of the diet of 
rickety children ; and in many inftances I can 
affirm, that it did not prevent the cure of the 
difeafe. In cafes, however, of any appear- 
ance of rickets, and particularly of a flow 
dentition, I have diffuaded the continuance 
of a child upon the bread ; becaufe the milk 
of women is a more watery nourifhment than 

Vol. III. P that 



326 PRACTICE 

that of cows : And I have efpecially difiuad- 
ed the continuing a child upon the breaft, 
when I thought the nurfe gave rather too 
much of fuch a watery nourifhment ; for, as 
has been above mentioned, I have had fre- 
quent occafion to fufpecl:, that the milk of 
luch nurfes has a tendency to favour the com- 
ing on of rickets. 



MDCCXXXV. 



Befides the remedies and regimen now 
mentioned, practitioners have commonly em- 
ployed in this dileafe, both emetics and pur- 
gatives. When the appetite and digeflion 
are confiderably impaired, vomiting, if nei- 
ther violent, nor frequently repeated, feems 
to be of fervice ; and by a moderate agita- 
tion of the abdominal vifcera, may in fome 
meafure obviate the ftagnation and confe- 
quent fwelling that ufually occur in them. 

As the tumid flate of the abdomen, fo con- 
flan tly to be met with in this difeafe, feems 
to depend very much upon a tympanitic af- 
fection of the inteftines ; fo, both by obviat- 
ing this, and by deriving from the abdominal 
vifcera, frequent gentle purgatives may be of 
fervice. Zeviani, perhaps properly, recom- 
mends in particular rhubarb ; which, befides 
its purgative quality, has thofe alfo of bitter 
and aftrin^ent. 

MDCCXXXVI. 



OF PHYSIC. 327 



MDCCXXXVI. 

I have now mentioned moft of the reme- 
dies commonly employed by the practitioners 
of former times ; but I mufl not omit men- 
tioning fome others that have been lately fug- 
gelled. The late Mr. De Haen recommends 
the teflacea ; and aflures us of their having 
been employed with fuccefs : But in the few 
trials which I have had occafion to make, 
their good effects did not appear. 

The late Baron Van Swieten gives us one 
inflance of rickets cured by the ufe of hem- 
lock ; but I do not know- that the practice 
has been repeated. 



£a BOOK 



32S 












BOOK III. 



of the IMPETIGINISj or DEPRAV- 
ED HABIT, with AFFECTIONS 

OF THE SKIN. 



MDCCXXXVII, 

I F I N D it difficult to give 
any fufficiently correct and proper charatter 
of this order. The difeafes comprehended 
Under it, depend, for the mofl part, upon a 
depraved flate of the whole of the fluids, 
producing tumours, eruptions, or other pre- 
ternatural affections of the fkin. Although 
it be extremely difficult to find a general 
character of the order that will apply to each 
of the genera and fpecies, I fhall here treat 
of the principal genera which have been 
commonly comprehended under this order, 
and which I have enumerated in my No- 
fology. 

C HA P, 



OF PHYSIC. 329 



CHAP. r. 



of SCROPHULA, or the KING'S 
EVIL. 



MDCCXXXVIII. 

1 HE chara&er of this difeafe 
I have attempted in my Nofology : But it 
will be more properly taken from the whole 
of its hiftory, now to be delivered. 

MDCCXXXIX. 

It is commonly, and very generally, a he- 
reditary difeafe ; and although it fometimes 
may, yet it rarely appears, but in children 
whole parents had at fome period of their 
lives been affected with it. Whether it may 
not fail to appear in the children of fcrophu- 
lous parents, and difcover itfelf afterwards in 
their offspring in the fucceeding generation, 
I cannot certainly determine ; but believe 
that this has frequently happened. It ap- 
pears to me to be derived more commonly 
from fathers than from mothers ; but whether 
this happens from there being more fcrophu- 
P 3 lous 



33° 



PRACTICE 



lous men than fcrophulous women married, I 
am not certain. 

With refpect to the influence of parents in 
producing this difeafe, it deferves to be re- 
marked, that in a family of many children, 
when one of the parents has been affected 
with fcrophula, and the other not ; as it is 
ufual for fome of tfce children to be in confti- 
tution pretty exactly like the one parent, and 
others of them like the other ; it commonly 
happens that thofe children who moft refem- 
ble the fcrophulous parent become affected 
with fcrophula, while thofe refembling the 
other parent entirely efcape. 

MDCCXL. 

The fcrophula generally appears at a par- 
ticular period of life. It feldom appears in 
the firft, or even in the fecond year of a 
child'^ life ; and moft commonly it occurs 
from the fecond, or, as fome allege, and per- 
haps more properly, from the third, to the 
feventh year. Frequently, however, it dif- 
covers itfelf at a later period ; and there are 
inftances of its firft appearance, at every pe- 
riod till the age of puberty ; after which, 
however, the firft appearance of it is very rare. 

MDCCXLI. 

When it does not occur very early, we can 
generally diftinguifh the habit of body pecu- 
liarly 



OF PHYSIC. 331 

liarly difpofed to it. It moft commonly af- 
fects children of foft and flaccid habits, of fair 
hair and blue eyes ; or at lead affefts thofe 
much more frequently than thofe of an op- 
pofite complexion. It affecls efpecially chil- 
dren of fmooth fkms and rofy cheeks ; and 
fuch children have frequently a tumid upper 
lip, with a chop in the middle of it j and this 
tumour is often confiderable, and extended to 
the columna nafi and lower part of the nof- 
tril-s. The difeafe is fometimes joined with, 
or follows rickets ; and although it frequently 
appears in children who have not had rickets 
in any great degree, yet it often attacks thofe 
who by a protuberant forehead, by tumid 
joints, and a tumid abdomen, fhow that they 
had fome rachitic difpofition. In parents 
who, without having had the difeafe them- 
felves, feem to produce fcrophulous children, 
we can commonly perceive much of the fame 
habit and conftitution that has been juft now 
defcribed. 

Some authors have fuppofed that the fmall 
pox has a tendency to produce this difeafe ; 
and Mr. De Haen afferts its following the in- 
oculated, more frequently than the natural, 
fmall pox. This lad pofition, however, we 
can confidently affirm to be a miftake ; al- 
though it muft be allowed, that in fatt the 
fcrophula does often come on immediately 
after the fmall pox. It is, however, difficult 
to find any connexion between the two dif- 
eafes. According to my obfervation, the ac- 
P 4 cident 



33 2 



PRACTICE 



cident only happens in children who have 
pretty mamfeflly the fcrophulous difpofition ; 
and I have had feveral inftances of the nat- 
ural fmall pox coming upon children affecled 
at the fame time with fcrophula, not only 
without this difeafe being any ways aggravat- 
ed by the fmall pox, but even of its being for 
lome time after much relieved. 

MDCCXLII. 

The fcrophula generally (hows itfelf firfl at 
a particular feafon of the year ; and at fome 
time between the winter and fummer folftice; 
but commonly long before the latter period. 
It is to be obferved further, that the courfe of 
the difeafe is ufually connecled with the courfe 
of the feafons. Whilft the tumours and ul- 
cerations peculiar to this difeafe, appear firft 
in the fpring, the ulcers are frequently healed 
up in the courfe of the fucceeding fummer, 
and do not break out again till the enfuing 
fpring, to follow again with the feafon the 
fame courfe as before. 

MDCCXLIII. 

I 
Frequently the firft appearance of the dif-,. 
cafe is the tumid and chopped lip above men-,, 
tioned. Upon other occafions the firft ap- 
pearance is that of fmall fpherical or oval tu-?i 
mours, moveable under the fkin. They are* 
foft, but with fome elafticity. They are 

without 



OF PHYSIC. 333 

without pain ; and without any change in the 
colour of the fkin. In this itate they often 
continue for a long time ; even for a year or 
two, and fometimes longer. Moll commonly 
they firfl appear upon the fides of the neck 
below the ears ; but fometimes alfo under the 
chin. In either cafe, they are fuppofed to 
affect in thefe places the conglobate or lym- 
phatic glands only ; and not at all the falivary 
glands, till the difeafe is very greatly advanced. 
The difeafe frequently affects, and even at 
firfl. appears in, other parts of the body. In 
particular, it affects the joints of the elbows 
and ankles, or thofe of the fingers and toes. 
The appearances about the joints are not 
commonly, as elfewhere, fmall moveable 
fwellings ; but a tumour almoft uniformly 
furrounding the joint, and interrupting its 
motion. 

MDCCXLIV. 

Thefe tumours, as I have faid, remain for 
fome time little changed ; and, from the time 
they firfl appeared in the fpring, they often 
continue in this way till the return of the fame 
feafon in the next,.or perhaps the fecond year 
after. About that time, however, or perhaps 
in the courfe of the feafon in which they firfl 
appear, the tumour becomes larger and more 
fixed ; the fkin upon it acquires a purple, 
feldom a clear rednefs : But growing redder 
by degrees, the tumour becomes fofter, and 

Voi. 3. P 5 allows 






334 PRACTICE 

allows the flu&uation of a liquid within to 
be perceived. All this procefs, however, 
takes place with very little pain attending it. 
At length fome part of the fkin becomes paler; 
and by one or more fmall apertures a liquid 
is poured out. 

MDCCXLV. 

The matter poured out has at firfl; the ap- 
pearance of pus, but it is ufually of a thinner 
kind than that from phlegmonic abfcefTes ; 
and the matter as it continues to be discharg- 
ed, becomes daily lefs purulent, and appears 
more and more a vifcid ferum, intermixed 
with fmall pieces of a white fubflance refem- 
bling the curd of milk. By degrees the tu- 
mour almoft entirely fubfides, while the ulcer 
opens more, and fpreads broader ; unequally, 
however, in different directions, and therefore 
is without any regular circumfcription. The 
edges of the ulcer are commonly flat and 
fmooth, both on their outfide and their inner 
edge, which feldom puts on a callous appear- 
ance. The ulcers, however, do not generally 
fpread much, or become deeper ; but at the 
lame time their edges do not advance, or put 
on any appearance of forming a cicatrix. 

MDCCXLVI. 

In this condition the ulcers often continue 
for a long time ; while new tumours, with ul- 
cers 



OF PHYSIC. 335 

cers fucceeding them in the manner above 
defcribed, make their appearance in different 
parts of the body. Of the firfl ulcers, how- 
ever, fome heal up, while other tumours and 
ulcers appear in their vicinity, or in other 
parts of the body : And in this manner the 
difeafe proceeds, for^e of the ulcers healing 
up, at lead to a certain degree, in the courfe 
of fummer, and breaking out again in the fuc- 
ceeding fpring : Or it continues, by new tu- 
mours and ulcers fucceeding them, in the 
fpring feafon, making their appearance fuc- 
ceflively for feveral years. 

MDCCXLVII. 

In this way the difeafe goes on for feveral 
years; but very commonly in four or five 
years it is fpontaneoufly cured, the former 
ulcers being healed up, and no new tumours 
appearing : And thus at length the difeafe 
ceafes entirely, leaving only fome indelible 
efchars, pale and frnooth, but in fome parts 
ihrivelled ; or, where it had occupied the 
joints, leaving the motion of thefe impaired, 
or entirely deftroyed. 

MDCCXLVIII. 

Such is the moft favourable courfe of this 

difeafe ; and with us, it is more frequently 

fuch, than otherwife : But it is often a more 

violent, and fometimcs a fatal malady. In 

P 6 ' thefe 







6 PRACTICE 



thefe cafes, more parts of the body are at the 
fame time affe&ed ; the ulcers alfo feeming 
to be imbued with a peculiarly fharp acrimo- 
ny, and therefore becoming more deep, erod- 
ing, fpreading, as well as feldomer healing up. 
In fuch cafes, the eyes are often particularly 
affetted. The edges of i he eyelids are affect- 
ed with tumour and fuperficial ulcerations ; 
and thefe commonly excite obftinate inflam- 
mation in the adnata, which frequently pro- 
duces an opacity of the cornea. 

When the fcrophula efpecially affefts the 
joints, it fometimes produces there confidera- 
ble tumours ; in the abfcefFes following which, 
the ligaments and cartilages are eroded, and 
the adjoining bones are affected with a caries 
of a peculiar kind. In thefe cafes, alfo, of 
more violent fcrophula, while every year pro- 
duces a number of new tumours and ulcers, 
their acrimony feems at length to taint the 
whole fluids of the body, occafioning various 
diforders ; and particularly a he&ic fever, 
with all its fymptoms, which at length proves 
fatal, with fometimes the fvmptoms of a 
phthifis pulmonalis. 

MDCCXLIX. 

The bodies of perfons who have died of 
this difeafe (how many of the vifcera in a very 
morbid ftate ; and particularly mod of the 
glands of the mefentery very much tumefied, 
and frequently in an ulcerated ftate. Com- 
monly 



OF PHYSIC. 337 

monly alfo a great number of tubercles or 
cyfls, containing matter of various kinds, ap- 
pear in the lungs. 

MDCCL. 

Such is the hiflory of the difeafe ; and from 
thence it may appear, that the nature of it is 
not eafily to be ascertained. It feems to be a 
peculiar affe&ion of the lymphatic fyflem ; 
and this in fome meafure accounts for its con- 
nexion with a particular period of life. Prob- 
ably, however, there is a peculiar acrimony 
of the fluids that is the proximate caufe of the 
difeafe; although of what nature this is, has 
not yet been discovered. It may perhaps be 
generally diffufed in the fyflem, and exhaled 
into the feveral cavities and cellular texture of 
the body ; and therefore, being taken up by the 
abforbents, may difcover itfelf efpecially in the 
lymphatic fyflem. This, however, will hard- 
ly account for its being more confined to that 
fyflem, than happens in the cafe of many oth- 
er acrimonies which may be fuppofed to be as 
generally diffufed. In fhort, its appearance 
in particular conftitutions, and at a particular 
period of life, and even its being a hereditary 
difeafe, which fo frequently depends upon the 
tranfmimon of a peculiar conflitution, are all 
of them circumftances which lead me to con- 
clude, upon the whole, that this difeafe de- 
pends upon a peculiar conjlilution of the lym- 
phatic fyjlem. 

MDCCLI. 



338 PRACTICE 

MDCCLI. 

It feems proper to obferve here, that the 
fcrophula does not appear to be a contagious 
difeafe ; at leaft I have known many inftances 
of found children having had frequent and 
clofe intercourfe with fcrophulous children 
without being infe&ed with the difeafe. This 
certainly mows, that in this difeafe the pecu- 
liar acrimony of it is not exhaled from the 
furface of the body, but that it depends 
efpecially upon a peculiar conflitution of the 
fyfiem. 

MDCCLII. 



Several authors have fuppofed the fcroph- 
ula to have been derived from the venereal 
difeafe; but upon nojuft grounds that I can 
perceive. In very many inftances; there can 
hardly be any fufpicion of the parents pro- 
ducing this difeafe having been imbued with 
fiphylis, or with any fiphylitic taint ; and I 
have known feveral examples of parents con- 
veying fiphylis to their offspring, in whom, 
however, no fcrophulous fymptoms at any 
time afterwards appeared. Further, the 
fymptoms of the two difeafes are very differ- 
ent ; and the difference of their natures ap- 
pears particularly from hence, that while mer- 
cury commonly and readily cures the fiphy- 
lis, 



OF PHYSIC. 339 

lis, it does no fervice in fcrophula, and very 
often rather aggravates the difeafe. 

MDCCLIII. 

For the cure of fcrophula, we have not yet 
learned any practice that is certainly or even 
generally fuccefsful. 

The remedy which feems to be the moft 
fuccefsful, and which our practitioners efpec- 
ially trull to and employ, is the ufe of mineral 
waters ; and indeed the warning out, by means 
of thefe, the lymphatic fyftem, would feem 
to be a meafure promifing fuccefs : But in 
very many inftances of the ufe of thefe waters, 
I have not been well fatisfied that they had 
fhortened the duration of the difeafe more 
than had often happened when no fuch rem- 
edy had been employed. 

MDCCLIV. 

With regard to the choice of the mineral 
waters moft fit for the purpofe, I cannot with 
any confidence give an opinion. Almoft all 
kinds of mineral waters, whether chalybeate, 
fulphureous, or faline, have been emploved 
for the cure of fcrophula, and feemingly with 
equal fuccefs and reputation : A circumftance 
which leads me to think, that, if they are ever 
fuccefsful, it is the elementary water that is 
the chief part of the remedy. 

Of 






34 o PRACTICE 

Of late, fea water has been efpecially rec- 
ommended and employed ; but after nume- 
rous trials, I cannot yet difcover its fuperior 
efficacy. 

MDCCLV. 

The other remedies propofed by practical 
writers are very numerous ; but, upon that 
very account, I apprehend they are little to 
be trufted ; and as I cannot perceive any juft 
reafon for expecting fuccefs from them, I have 
very feldom employed them. 

Of late, the Peruvian bark has been much 
recommended : And as in fcrophulous per- 
fons there are generally fome marks of laxity 
and flaccidity, this tonic may poffibly be of 
fervice ; but in a great variety of trials, I 
have never feen it produce any immediate 
cure of the difeafe. 

In feveral inflances, the leaves of coltsfoot 
have appeared to me to be fucceisful. I have 
ufed it frequently in a ftrong decoction, and 
even then with advantage ; but have found 
more benefit from the exprefled juice,, when 
the plant could be had in fomewhat of a fuc- 
culent flate, foon after its firil appearance in 
the fpring. 

MDCCLVI. 

I have alfo frequently employed the hem- 
lock, and have fome times found it uieful in 

di feu (liner 
o 



OF PHYSIC. 341 

difcufling obfh'nate (Veilings : But in this, it 
has alio often di (appointed me ; and I have 
not at any time oblerved that it difpofed 
fcrophulous ulcers to heal. 

I cannot conclude the fubjecl: of internal 
medicines without remarking, that I have 
never found, either mercury or antimony, in 
any ftiape, of ufe in this difeafe ; and when 
any degree of a feverifh (late had come on, the 
ufe of mercury proved manifeftly hurtful. 

MDCCLVII. 

In the progrefs of fcrophula, feveral exter- 
nal medicines are requifite. • Several applica- 
tions have been ufed for difcufling the tu- 
mours upon their firft coming on ; but hith- 
erto my own practice, in thefe refpe&s, has 
been .attended with very little fuccefs. The 
folution of faccharum iaturni has feemed to 
be ufeful ; but it has more frequently failed : 
And I have had no better fuccefs with the 
fpiritus Mindereri. Fomentations of every 
kind have been frequently found to do harm ; 
and poultices feem only to hurry on a fup- 
puration. I am doubtful if this lad be ever 
pra&ifed with advantage j for fcrophulous 
tumours fomctimes fpontaneoufly difappear, 
but never after any degree of inflammation 
has come upon them ; and therefore poul- 
tices, which commonly induce inflammation, 
prevent that difcuflion of tumours, which 
might otherwife have happened. 

Even 



342 PRACTICE 

Even when fcrophulous tumours have ad- 
vanced towards fuppuration, I am unwilling 
to haften the fpontaneous opening, or to make 
it by the lancet ; becaufe I apprehend the 
fcrophulous matter is liable to be rendered 
more acrid by communication with the air, 
and to become more eroding and fpreading 
than when in its inclofed ftate. 

MDCCLVIII. 

The management of fcrophulous ulcers 
has, fo far as I know, been as little fuccefsful 
as that of the tumours. Efcharotlc prepara- 
tions, of either mercury or copper, have been 
fometimes ufeful in bringing on a proper fup- 
puration, and thereby difpofing the ulcer to 
heal j but they have feldom fucceeded, and 
more commonly they have caufed the ulcer 
to fpread more. The efcharotic from which 
I have received moft benefit is burnt alum ; 
and a portion of that mixed with a mild oint- 
ment, has been as ufeful an application as any 
I have tried. The application, however, that 
I have found moft ferviceable, and very uni- 
verfally admiffible, is that of linen cloths 
wetted with cold water, and frequently chang- 
ed when they are becoming dry, it being in- 
convenient to let them be glued to the fore. 
They are therefore to be changed frequently 
during the day ; and a cloth fpread with a 
mild ointment or plafter may be applied for 
the night. In this practice I have fometimes 

employed 



OF PHYSIC. 343 

employed fea water : But generally it proved 
too irritating ; and neither that nor any min- 
eral water has appeared to be of more fervice 
than common water. 

MDCCLIX. 

To conclude what I have to offer upon the 
cure of fcrophula, I mud obferve, that cold 
bathing feems to have been of more benefit 
than any other remedy that I have had occa- 
fion to fee employed. 



CHAP. 



344 PRACTICE 



C H A P. II. 



of SIPHYLIS, or the VENTEREAL 
DISEASE. 



MDCCLX. 

AFTER practitioners have 
had fo much experience in treating this dif- 
eafe, and after fo many books have been pub- 
lifhed upon the fubjecl:, it does not feem »ec- 
efTary, or even proper, for me to attempt any 
full treatife concerning it ; and I fhall there- 
fore confine myfelf to fuch general remarks, 
as may ferve to illuftrate forne parts of the 
pathology or of the practice. 

MDCCLXI. 

It is fufhciently probable, that, anciently, 
in certain parts of Afia, where the leprofy 
prevailed, and in Europe after that difeafe 
had been introduced into it, a difeafe of the 
genitals, refembling that which now common- 
ly arifes from fiphylis, had frequently appear- 
ed : But it is equally probable, that a new 
difeafe, and what we at prefent term Siphylis, 
was firfl brought into Europe about the end 
N --x of 



OF PHYSIC. 345 

of the fifteenth century ; and that the diflem- 
per now fo frequently occurring, has been 
very entirely derived from that which was 
imported from America at the period men- 
tioned. 

MDCCLXII. 

This difeafe, at leafl in its principal circum- 
{lances, never arifes in any perfon but from 
fome communication with a perfon already 
afFected with it. It is moft commonly con- 
tracted in confequence of coition with an in- 
fected perfon ; but in what manner the in- 
fection is communicated, is not clearly ex- 
plained. I am perfuaded, that in coition, it 
is communicated without there being any 
Open ulcer either in the perfon communicat- 
ing or in the perfon receiving the infection ; 
but in all other cafes, I believe it is never 
communicated in any other way than by a 
contact of ulcer, either in the perfon com- 
municating, or in the perfon receiving the 
infection. 

MDCCLXIII. 

As it thus arifes from the contact of partic- 
ular parts, fo it always appears firft in the 
neighbourhood of the parts to which the in- 
fecting matter had been immediately applied ; 
and therefore, as moft commonly contracted 

by 



346 PRACTICE 

by coition, it generally appears firft in the 
genitals. 

MDCCLXIV. 

After its firft appearance in particular 
parts, more efpecially when thefe are the 
genitals qf either fex, its effects for fome time 
feem to be confined to thefe parts ; and in- 
deed, in many cafes, never extends further. 
In other cafes, however, the infecting mat- 
ter palfes from the parts firft affected, and 
from the genitals therefore, into the bloodvef- 
fels ; and being there diffufed, produces dis- 
orders in many other parts of the body. 

From this view of the circumftances, phy- 
ficians have very properly diftinguifhed the 
different ftates of the difeafe, according as 
they are local or are more univerfal. To the 
former, they have adapted appellations fuited 
to the manner in which the difeafe appears; 
and to the other the general affection, they 
have almoft totally confined the appellations 
of Siphylisy Lues Venerea y or Pox. In the re- 
marks I am now to offer, I fhall begin with 
confidering the local affection. 

MDCCLXV. 

This local affection appears chiefly in the 
form of gonorrhoea or chancre. 

The phenomena of gonorrhoea either upon 
its firft coming on or in its after progrefs, or 

the 



OF PHYSIC. 347 

the fymptoms of ardor urinae, chordee, or 
others attending it, it is not neceflary for me 
to defcribe. I fhall only here obferve, that 
the chief circumftance to be taken notice of, 
is the inflamed ftate of the urethra, which I 
take to be infeparable from the difeafe. 

MDCCLXVI. 

In thefe well known circumftances, the 
gonorrhoea continues for a time longer or 
fhorter, according to the conflitution of the 
patient ; it ufually remaining longeft in the 
mod vigorous and robuft, or according to the 
patient's regimen, and the care taken to re- 
lieve or cure the diieafe. In many cafes, if 
by a proper regimen the irritation of the in- 
flamed ftate is carefully avoided, the gonor- 
rhcea^fpontaneoufly ceafes, the fymptoms of 
inflammation gradually abating, the matter 
difcharged becoming of a thicker and more 
vifcid confidence, as well as of a whiter col- 
our ; till at length, the flow of it ceafes alto- 
gether ; and whether it be thus cured fpon- 
taneoufly, or by art, the difeafe often exifts 
without communicating any infection to the 
other parts of the body. 

MDCCLXVII. 

In other cafes, however, the difeafe having 
been negle&ed, or by an improper regimen 
•aggravated, it continues with all its fymptoms 

for 



m 



348 PRACTICE 

« 

for a long time ; and produces various other 
disorders in the genital parts, which, as com- 
monly taken notice of by authors, need not 
be defcribed here. I fhall only obferve, that 
the inflammation of the urethra, which at firfl 
feems to be feated chiefly, or only, in its an- 
terior parts, is in fuch neglected and aggravat- 
ed cafes ipread upwards along the urethra, 
even to the neck of the bladder. In thefe 
circumftances, a more confiderable inflam- 
mation is occafioned in certain parts of the 
urethra ; and confequently, fuppuration and 
ulcer are produced, by which the venereal 
poifon is fometimes communicated to the fyf- 
tem, and gives rife to a general fiphylis. 

MDCCLXVIII. 

It was fome time ago a pretty general fup- 
pofition, that the gonorrhoea depended al- 
ways upon ulcers of the urethra, producing a 
difcharge of purulent matter ; and fuch ul- 
cers do indeed fometimes occur in the manner 
that has been juft now mentioned. We are 
now aflured, however, from many di flections 
of perfons who had died when labouring un- 
der a gonorrhoea, that the difeafe may exift, 
and from many considerations it is probable 
that it commonly does exift, without any 
ulceration of the urethra ; fo that the dif- 
charge which appears, is entirely that of a 
vitiated mucus from the mucous follicles of 
the urethra. 

MDCCLXIX. 



OF PHYSIC. 340 

MDCCLXIX. 

Although moft of the fymptoms of gonor- 
rhoea fhould be removed, yet it often happens 
that a mucous fluid continues to be difcharg- 
ed from the urethra for a long time after, and 
fometimes for a great part of a perfon's life. 
This difcharge is what is commonly called a 
Gleet. 

With refpecl to this, it is proper to obferve, 
that in fome cafes, when it is certain that the 
matter difcharged contains no venereal poifon, 
the matter may, and often does put on that 
puriform appearance, and that yellow and 
greeniih colour, which appears in the difcharge 
at the beginning and during the courfe of a 
virulent gonorrhoea. Thefe appearances in 
the matter of a gleet which before had been 
of a lefs coloured kind, have frequently given 
occafion to fuppofe that a frefh infe&ion had 
been received : But I am certain that fuch 
appearances may be brought on by, perhaps, 
various other caufes ; and particularly, by in, 
temperance in venery and drinking 'concur- 
ring together. I believe, indeed, that this 
feldom happens to any but thofe who had' be- 
fore frequently laboured under a virulent 
gonorrhoea, and have more or lefs of gleet- 
remaining with them : But I muft alfo ob- 
lerVe, that in perfons who at no period of their 
lite had ever laboured under a virulent gon- 
orrhoea, or any other fymptom of fiphylitic 

Vol. III. ' O affediom 



35 o PRACTICE 

affe&ion, I have met with in Ranees of dif- 
charges from the urethra refembling thofe of 
a virulent gonorrhoea. 

The purpofe of thefe obfervations is, to 
fuggeft to practitioners what I have not found 
them always aware of, that in perfons labour- 
ing under a gleet, fuch a return of the appear- 
ances of a virulent gonorrhoea may happen 
without any new infection having been re- 
ceived, and confequently not requiring the 
treatment which a new infection might per. 
haps demand. When in the cure of gonor- 
rhoea it was the practice to employ purgatives 
very frequently, and fometimes thofe of the 
draftic kind, I have known the gleet, or fpu- 
•rious gonorrhoea, by fuch a practice much in- 
creafed, and long continued, and the patient's 
■conftitution very much hurt. Nay, in order 
•more certainly further to prevent miftakes, it 
is to be obferved, that the fpurious gonorrhoea 
is fometimes attended with heat of urine, and 
fome degree of inflammation ; but thefe 
fymptoms are feldom confiderable, and, mere* 
ly by the afllftance of a cool regimen, con> 
xnonly difappear in a few days. 

MDCCLXX, 

With refpeel; to the cure of a virulent gon« 
orrhcea, I have only to remark, that if it be 
true, as I have mentioned above, that the 
difeafe will often, under a proper regimen, be 
fpontaneoufly cured ; and that the whole of 



Of physic. 351 

the virulent matter may be thus entirely dif- 
charged without the afliflance of art ; it would 
feem that there is nothing required of prac- 
titioners, but to moderate and remove that 
inflammation which continues the difeafe, and 
occafions all the troublefome fymptoms that 
ever attend it. The fole bufinefs therefore 
of our art in the cure of gonorrhoea, is to 
take off the inflammation accompanying it c 
And this I think may commonly be done, bf 
avoiding exercife, by ufing a low and cool 
diet, by abftaming entirely from fermented 
and fpirituous liquors, and by taking plenti- 
fully of mild diluent drinks. 

,: MDCCLXXI. 

The heat of urine, which is fo troublefome 
in this difeafe, as it arifes from the increafed 
fenfibility of the urethra in its inflamed ftate ; 
fo, on the other hand, the irritation of. the 
urine has the effecl: of increafing the inflam* 
mation, and is therefore to be removed as foon 
as poflible. This can be done moll effe&u*. 
ally by taking in a large quantity of mild 
watery liquors. Demulcents may be em- 
ployed ; but unlefs they be accompanied with 
a large quantity of water, they will have little 
effect. 1 Nitre has been commonly employed 
as a fuppofed refrigerant : But, from much 
observation, I am convinced, that in a fmall 
quantity it is ufelefs, and in a large quan- 
tity certainly hurtful ; and, for this rea- 
Q 2 fon, 



35 2 PRACTICE 

fon, that every faline matter palling with the 
urine generally gives fome irritation to the 
urethra. To prevent the irritation of the 
urethra arifmg from its increafed fenfibility, 
the injection of mucilage or of mild oil into 
it has been practifed ; but I have feldora 
found this of much fervice. 

MDCCLXXII. 

In gonorrhoea, as coflivenefs may be hurt- 
ful, both by an irritation of the fyftem in gen- 
eral, and of the urethra in particular, as this 
is occafioned always by the voiding of hard- 
ened faeces ; fo coflivenefs is to be carefully 
avoided or removed ; and the frequent ufe of 
large glyfters of water and oil, I have found 
of remarkable benefit in this difeafe. If 
clyfters, however, do not entirely obviate cof- 
tivenefs, it will be neceffary to give laxatives 
by the mouth : Which, however, fhould be 
of the mildeft kind, and fhould do no more 
than keep the belly regular and a little loofe, 
without much purging. 

The practice of frequent purging, which 
was formerly fo much in ufe, and is not yet 
entirely laid afide, has always appeared to me 
to be generally fuperfluous, and often very 
hurtful. Even what are fuppofed to be cool- 
ing purgatives, fuch as Glauber's fait, foluble 
tartar, and cryftals of tartar, in fo far as any 
part of them pafs by urine, they, in the fame 
manner as we have faid of nitre, may be hurt- 
ful i 



OF PHYSIC. 853 

ful ; and fo far as they produce very liquid 
flools, the matter of which is generally acrid, 
they irritate the reclum, and confequently the 
urethra. This laft effeft, however, the acrid, 
and in any degree draflic purgatives, more- 
certainly produce. 

MDCCLXXIII. 

In cafes of a gonorrhoea attended with vi- 
olent inflammation, bloodletting may be of 
fervice ; and in the cafe of perfons of a robuft 
and vigorous habit, in whom .the difeafe is 
commonly the moft violent, bloodletting may 
be very properly employed. As general 
bleedings, however, when there is no phlo- 
giflic diathefis in the fyflem, have little effect 
in removing topical inflammation ; fo in gon- 
orrhoea, when the inflammation is confidera- 
ble, topical bleeding applied to the urethra 
by leeches, is generally more effectual in re- 
lieving the inflammation. 

MDCCLXXIV. 

When there is any phymofis attending a 
gonorrhoea, emollient fomentations applied 
to the whole penis are often of fervice. In 
fuch cafes it is neceffary, and in all others 
ufeful, to keep the penis laid up to the belly, 
when the patient either walks about or is 
fitting. 

Q 3 MDCCLXXV. 



S5 4 PRACTICE 

MDCCLXXV. 

Upon occafion of frequent pirapifm and 
chordee, it has been found ufeful to apply to 
the whole of the penis a poultice of crumb of 
bread moiflened with a ftrong folution of 
iugar of lead. I have, however, been often 
difappointed in this practice, perhaps by the 
poultice keeping the penis too warm, and 
thereby exciting the very fymptoms I wifhed 
to prevent. Whether lotions of the external 
urethra with a folution of the fugar of lead, 
might be ufeful in this cafe, I have not prop- 
erly tried. 

MDCCLXXVI. 

With refpect to the ufe of injections, fo 
frequently employed in gonorrhoea, I am 
perfuaded, that the early ufe of aflringent in- 
jections is pernicious ; not by occafioning a 
iiphylis, as has been commonly imagined ; 
but by increafing and giving occafion to all 
the confequences of the inflammation, partic- 
ularly to the very troublefome fymptoms of 
fwelled tefticles. When, however, the difeafe 
has continued for fome time, and the inflam- 
matory fymptoms have very much abated, I 
am of opinion, that by injections of moderate 
aftringency, or at leaft of this gradually in- 
creafed, an end may be fooner put to the dif- 
eafe than would otherwife have happened ; 

and 



OF PHYSIC. 355 

and that a gleet, fo readily occurring, may be 
generally prevented. 

MDCCLXXVII. 

Be fides the ufe of aftringent injections, ifr 
has been common enough to employ thofe of 
a mercurial kind. With refpect. to thefe, al- 
though I am convinced that the infection 
producing gonorrhoea, and that producing 
chancres and fiphylis, are one and the fame ; 
yet I apprehend, that in gonorrhoea mercury 
cannot be of ufe by correcting the virulence 
of the infection ; and therefore that it is not 
univerfally neceffary in this difeafe. I am 
perfuaded, however, that mercury applied to 
the internal furface of the urethra, may be of 
ufe in promoting the more full and free dis- 
charge of virulent matter from the mucous 
glands of it. Upon this fuppolition, I have 
frequently employed mercurial injections j 
and, as I judge, with advantage ; thofe injec- 
tions often bringing on fuch a ftate of the 
confiftence and colour of the matter difcharg- 
ed, as we know ufually to precede its fpon- 
taneous ceafing. I avoid thefe injections, 
however, in recent cafes, or while much in- 
flammation is ftill prefent ; but when that in- 
flammation has fomewhat abated, and the 
difcharge notwithstanding ftill continues in a 
virulent form, I employ mercurial injections 
freely. I employ thofe only that contain 
mercury entirely in a liquid form, and avoid 
Q 4 thofe 



356 PRACTICE 

thofe which may depofite an acrid powder in 
the urethra. That which I have found mod 
uieful is a folution of the corrofive fublimate 
in water ; fo much diluted as not to occafion 
any violent fmarting, but not fo much diluted 
as to give no fmarting at all. It is fcarce 
necefTary to add, that when there is reafon to 
fufpect there are ulcerations already formed 
in the , urethra, mercurial injections are not 
only proper, but the only effectual remedy 
that can be employed. 

MDCCLXXVIII. 

With regard to the cure of gonorrhoea, I 
have only one other remark to offer. As 
raoft of the fymptoms arife from the irritation 
of a ftimulus applied, the effects of this irri- 
tation may be often leffened by diminifhing 
the irritability of the fyftem ; and it is well 
known, that the moft certain means of accom- 
plifhing this is by employing opium. For 
that reafon, I confider the practice both of 
applying opium directly to the urethra, and 
of exhibiting it by the mouth, to be extremely 
ufeful in moft cafes of gonorrhoea. 

MDCCLXXIX. 

After thus offering fome remarks with ref- 
pect to gonorrhoea in general, I might pro- 
ceed to confider particularly the various fymp- 
toms which fo frequently attend it ; but it 

does 



OF PHYSIC. 357 

docs not feem neceffary for me to attempt 
this after the late publications of Dr. Foart 
Simmons, and of Dr. Schwediaur, who have 
treated the fubjecl; fo fully, and with fo much 
difcernment and fkill. 



MDCCLXXX. 

The other form of the local aflPeclion of 
fiphylis, is that of chancre. The ordinary 
appearance of this I need not defcribe, it hav- 
ing been already fo often done. Of the few 
remarks I have to offer, the fir ft is, that I be- 
lieve chancres never appear in any degree 
without immediately communicating to the 
blood more or lefs of the venereal poifon : 
For I have conftantly,. whenever chancres 
had appeared, found, that unlefs mercury was 
immediately given internally, fome fymptoms 
of a general fiphylis did certainly come on 
afterwards ; and though the internal ufe of 
mercury mould prevent any fuch appearance, 
it is ftill to be prefumed that the poifon had 
been communicated, becaufe mercury could 
act upon it in no other manner than as dif- 
fufed in the fluids. 

MDCCLXXXI. 

It has been a queflion among pra&itioners, 

upon the fubjeft of chancres, Whether they 

Vol. 3. Q5 m *Y 



358 PRACTICE 

may be immediately healed up by applications 
made to the chancres, or if they mould be left 
open for lbme time without any fuch appli- 
cation ? It has been fuppofed, that the hid- 
den healing up of chancres might immediate- 
ly force into the blood a poifon which might 
have been excluded by being difcharged from 
the chancre. This, however, is a fuppofition 
that is very doubtful ; and, upon the other 
hand, I am certain, that the longer a chancre 
is kept open, the more poifon it perhaps gen- 
erates, and certainly fupplies it more copioufly 
to the blood. And although the above men- 
tioned fuppofition were true, it will be of little 
confequence, if the internal ufe of mercury, 
which I judge necelTary in every cafe of chan- 
cre, be immediately employed. I have often 
ieen very troublefome confequences follow 
from allowing chancres to remain unhealed; 
and the fymptoms of general fiphylis have 
always feemed to me to be more confiderable 
and violent in proportion as chancres had 
been fuflered to remain longer unhealed. 
They fhould always, therefore, be healed as 
foon as pcflible j and that, by the only very 
effectual means, the application of mercurials 
to the chancre itfelf. Thofe that are recent, 
and have not yet formed any confiderable ul- 
cer, may often be healed by the common mer- 
curial ointment ; but the moft powerful means 
of healing them has appeared to me, to be the 
application of red precipitate in dry a powder. 

MDCCLXXXII. 



OF PHYSIC. 359 



MDCCLXXXII. 

When, in confequence of chancres, or of 
the other circumftances above mentioned, by 
which it may happen the venereal poifon has 
been communicated to the blood, it produces 
many different fymptoms in different parts of 
the body, not neceffary to be enumerated and 
defcribed here, that having been already done 
by many authors with great accuracy. 

MDCCLXXXIII. 

Whenever any of thofe fymptoms do in any 
degree appear, or as foon as it is known that 
the circumftances- which give occafion to the 
communication of the venereal poifon have 
taken place, I hold the internal ufe of mercu- 
ry to be immediately neceffary ; and I am 
well perfuaded, that mercury employed with- 
out delay, and in fufficient quantity, will pret- 
ty certainly prevent the fymptoms which 
would otherwife have foon appeared, or will 
remove thofe that may have already difcover- 
ed themfelves. In both cafes, it will fecure 
the perfon from any future confequences of 
fiphylis from that infection. 

MDCCLXXXIV. 

This advice for the early and full life of 

mercury, I take to be the mod important that 

O 6 can 



360 PRACTICE 

can be given with refpecl to the venereal dif- 
eafe : And although I muft admit that the 
virulence of the poifon may be greater in one 
cafe than in another, and even that one con-, 
flitution may be more favourable than anoth- 
er to the violence of the difeafe ; yet I am 
thoroughly convinced, that mod of the in- 
ftances which have occurred of the violence 
and obftinacy of fiphylis have been owing 
very entirely to the neglett of the early ap- 
plication of mercury. 

MDCCLXXXV. 

Whatever other remedies of fiphylis may 
be known, or may hereafter be found out, 1 
cannot pretend to determine ; but I am well 
perfuaded, that in moll cafes mercury prop- 
erly employed will prove a very certain and 
effectual remedy. With refpecl; to others 
that have been propofed, I fhall offer this re- 
mark only, that I have found the decoclion 
of the mezereon contribute to the healing of 
ulcers which feemed to have refilled the pow- 
er of mercury. 

MDCCLXXXVJ. 

With regard to the many and various prep- 
arations of mercury, I do not think it necef- 
fary to give any enumeration of them here, as 
they are commonly very well known, and 
have been lately well enumerated by Dr. 

Schwediaur. 



OF PHYSIC. 361 

Schwediaur. The choice of them feems to 
be for the mofl part a matter of indifference ; 
as I believe cures have been, and ftill may be, 
effected by many different preparations, if 
properly adminiftered. The proper admin- 
iftration feems to confift,j?r/?, In the choofing 
thofe preparations which are the lead ready 
to run off by ftool ; and therefore the appli- 
cations externally by unttion, are in many 
cafes the moft convenient. 2cHy, In employ- 
ing the unttion, or in giving a preparation of 
mercury internally, in fuch quantity as may 
fhow its fenfible effecT:s in the mouth. And, 
^dly, without carrying thefe effects to a great- 
er length, In the continuing the employment 
of mercury for feveral weeks, or till the fymp- 
toms of the difeafe fhall have for fome time 
entirely difappeared. I fay nothing of the 
regimen proper and neceffary for patients dur- 
ing the employment of mercury, becaufe I 
prefume it to be very well known. 

MDCCLXXXVII. 

Amongft; the other preparations of mercu- 
ry, I believe the corrofive fublimate has often 
been employed with advantage : But I believe 
alfo, that it requires being continued for a 
longer time than is neceffary in the employ- 
ment of other preparations in the manner 
above propofed ; and I fufpecl; it has often 
failed in making a cure, becaufe employed 

while 



362 



PRACTICE 



while perfons were at the fame time expofed 
to the free air. 

MDCCLXXXVIII. 

Upon thefe points, and others relative to 
the adminiftration of mercury, and the cure 
of this difeafe, I might offer fome particular 
remarks : But I believe they are generally 
underftood ; and it is enough for me to fay 
here, that if practitioners will attend, and pa- 
tients will fubmit, to the general rules given 
above, they will feldom fail of obtaining a 
certain and fpeedy cure of the difeafe. 



CHAP. 



OF PHYSIC. 363 



CHAP. III. 



of SCURVY. 



MDCCLXXXIX. 

1 HIS difeafe appears fo fre- 
quently, and the effects of it are fo often fata], 
in fleets and armies, that it has very properly 
engaged the particular attention of phyficians. 
It is indeed furprifing that it had not fooner 
attracted the efpecial notice both of flatefmen 
and phyficians, fo as to have produced thofe 
meafures and regulations that might prevent 
the havock which it fo often occafions. Within 
thefe laft fifty years, however, it has been fo 
much attended to and fludied, that we might 
fuppofe every circumftance relating to it fo 
fully and exactly afcertained, as to render all 
further labour upon the fubjecl; fuperfluous. 
This perhaps may be true ; but it appears to 
me, that there are flill feveral circumftances 
regarding the difeafe not agreed upon among 
phyficians, as well as different opinions form- 
ed, fome of which may have a bad effect upon 
the practice : And this feems to me to be 
fo much the cafe, that I hope I lhall be ex- 
cufed in endeavouring here to ftate the fads 

as 



364 PRACTICE 

as they appear to me from the belt authorities, 
and to offer remarks upon opinions which 
may influence the practice in the prevention 
and cure of this difeafe. 



MDCCXC. 

With refpecl to the phenomena of the dif- 
eafe, they have now been fo fully obferved, 
and fo accurately defcribed, that there is no 
longer any doubt in difcerning the difeafe 
when it is prefent, or in diftmguifhing it from 
alrnoft every other ailment. In particular, it 
feems now to be fully determined, that there 
is one difeafe only, intitled to the appellation 
of Scurvy ; that it is the fame upon the land 
as upon the fea ; that it is the fame in all 
climates and feafons,as depending everywhere 
upon nearly the fame caufes ; and that it is 
not at all diverfified, either in its phenomena 
or its caufes, as had been imagined fome time 
ago. 

MDCCXCI. 



The phenomena of fcurvy, therefore, arc 
not to be defcribed here, as it has been fo fully 
and accurately done elfewhere ; and I mail 
only endeavour to afcertain thofe fa els with 
refpecl to the prevention and cure of the dif- 
eafe which feem not yet to be exactly agreed 
upon. And, firft, with refpecl to the ante- 
cedents 



OF PHYSIC. 365 

cedents that may be confidered as the remote 
caulcs of the difeafe. 

MDCCXCII. 

The moll remarkable circumftance amongit 
the antecedents of this difeafe is, that it has 
moll commonly happened to men living very 
much on falted meats ; and whether it ever 
arife in any other circumftances, is extremely 
doubtful. Thefe meats are often in a putref- 
cent flate j and to the circumftance of the 
long continued ufe of animal food in a pu- 
trescent and fomewhat indigeftible ftate, the 
difeafe has been efpecially attributed. Wheth- 
er the circumftance of the meat's being falt- 
ed, has any effect in producing the difeafe, 
otherwife than by being rendered more indi- 
geftible, is a queftion that remains ftill in dif- 
pute. 

MDCCXCIII. 

It feems to me, that the fait concurs in pro- 
ducing the effect. ; for there is hardly any in- 
ftance of the difeafe appearing unlefs where 
falted meats had been employed, and fcarcely 
an example where the long continued ufe of 
thefe did not produce it : Befides all which, 
there are fome inftances where, by avoiding 
falted meats, or by diminifhing the propor- 
tion of them in diet, while other circumftances 
remained much the fame, the difeafe was pre- 
vented 



g66 PRACTICE 

vented from appearing. Further, if it may 
be admitted as an argument upon this fubjecV 
I ftiall hereafter endeavour to (how, that the 
]arge ufe of fait has a tendency to aggravate 
and increafe the proximate caufe of fcurvy. 

MDCCXCIV. 

It muft however be allowed, that the prin- 
cipal circumftance in caufing fcuivy, is the 
living very much and very long upon animal 
food, efpecially when in a putrescent ftate ; 
and the clear proof of this is, that a quantity 
of frefh vegetable food will always certainly 
prevent the difeafe. 

MDCCXCV. 

While it has been held, that, in thofe cir- 
cumftances in which fcurvy is produced, the 
animal food employed was efpecially hurtful 
by its being of difficult digeftion, this opinion 
has been attempted to be confirmed, by ob- 
ferving, that the reft of the food employed in 
the fame circumftances was alfo of difficult 
digeftion. This is fuppofed to be efpecially 
the cafe of unfermented farinacea which fo 
commonly makes a part of the fea diet. But 
I apprehend this opinion to be very ill found- 
ed ; for the unfermented farinacea, which are 
in a great proportion the food of infants, of 
women, and of the greater part of mankind, 
can hardly be fuppofed to be food of difficult 

digeftion : 



OF PHYSIC. 367 

digeftion : And with refpect to the production 
of fcurvy, there are facts which fhow, that 
unfermented farinacea, employed in large 
proportion, have had a confiderable effect in 
preventing the difeafe. 



MDCCXCVI. 

It has been imagined, that a certain im- 
pregnation of the air upon the fea had an ef- 
fect in producing fcurvy. But it is altogeth- 
er improbable : For the only impregnations 
which could be fufpe&ed, are thofe of inflam- 
mable or mephitic air ; and it is now well 
known, that thefe impregnations are much 
lefs in the air upon the fea than in that upon 
the land ; befides, there are otherwife many 
proofs of the falubrity of the fea air. If, 
therefore, fea air have any effect in producing 
fcurvy, it mud be by its fenfible qualities of 
cold or moifture. 



MDCCXCV1I. 

That cold has an effect in favouring the 
production of fcurvy, is manifeft from hence, 
that the difeafe is more frequent and more 
confiderable in cold than in warm climates 
and feafons ; and that even warm clothing 
has a confiderable effect in preventing it. 

MDCCXCVIII. 



3 €8 PRACTICE 

MDCCXCVIII. 

Moifture may in general have an effeft in 
favouring the production of fcurvy, where 
that of the atmofphere in which men are 
placed is very confiderable : But the ordinary 
moiflure of the fea air is far from being fuch. 
Probably it is never confiderable, except in 
the cafe of unufual rains ; and even then, it 
is perhaps by the application of moifture to 
the bodies of men in damp clothing only 
that it has any fhare in the production of 
fcurvy. At the fame time, I believe there is 
no inftance of either cold or moiflure produc- 
ing fcurvy, without the concurrence of the 
faulty fea diet. 

MDCCXCIX. 

Under thofe circumftances which produce 
fcurvy, it commonly feems to occur moil 
readily in the perfons who are the leaft exer- 
cifed ; and it is therefore probable, that con- 
finement and want of exercife may have a 
great fhare in producing the difeafe. 

MDCCC. 

It appears that weaknefs, in whatever man- 
ner occafioned, is favourable to the produc- 
tion of fcurvy. It is therefore probable, that 
unufual labour and fatigue may often have 

fome 



OF PHYSIC. 369 

fome (hare in bringing it on : And upon the 
fame account, it is probable, that fadnefs and 
defpondency may induce a weaknefs of the 
circulation ; and thereby, as has been 
remarked, favourable to the production of 
fcurvy. 

MDCCCI. 

It has alfo been obferved, that perfons neg- 
ligent in keeping their fkin clean by warning 
and change of clothing, are more liable than 
others to be affected with fcurvy. 

MDCCCII. 

Several of thefe caufes, now mentioned, 
concurring together, feem to produce fcurvy ; 
but there is no proper evidence that any one 
of them alone will produce it, or that all the 
others uniting together 1 will do it, without the 
particular concurrence of the lea diet. A- 
longft with this, however, feveral of the other 
circumllances mentioned, have a great effect 
in producing it fooner, and in a more consid- 
erable degree, than would otherwife have hap- 
pened from the diet alone. 

MDCCCIII. 

From this view of the remote caufes, it will 
readily appear, that the prevention of the dif— 
eafe may in fome meafure depend upon the 

avoiding 



370 PRACTICE 

avoiding of thofe circum fiances which wc 
have enumerated as contributing to bring on 
the difeafe fooner than it would otherwife 
come on. At the fame time, the only effectu- 
al means will be, by avoiding the diet of fait- 
ed meats ; at leaft by lefifening the proportion 
of thefe, and ufing meat preferved otherwife 
than by fait ; by ufing in diet any kind of ef- 
culent vegetable matter that can be obtained ; 
and efpecially by ufing vegetable matters the 
mofl difpofed to acefcency, fuch as malt; 
and by drinking a large quantity of pure 
water, 

MDCCCIV. 

The cure of fcurvy feems now to be very 
well afcertained ; and when, the neceffary 
means can be obtained, the difeafe is com- 
monly removed very quickly. The chief 
means is a food of frefh and fucculent vegeta- 
bles, and thofe almoft of any kind that are 
at all efculent. Thofe mod immediately ef- 
fectual are the acid fruits, and, as being of the 
fame nature, all fort of fermented liquor. 

MDCCCV. 

iThe plants named alkalefeenty fuch as thofe 
of the garlic tribe and of the tetradynamiae, 
are alfo particularly ufeful in the cure of this 
difeafe ; for, notwithftanding their appellation, 
they in the firft part of their fermentation un- 
dergo 



OF PHYSIC. 371 

dergo an acefcency, and feem to contain a 
great deal of acefcent matter. At the fame 
time, they have generally in their compofition 
an acrid matter that readily paffes by urine, 
probably by perfpiration ; and by promoting 
both excretions, are ufeful in the difeafe. It 
is probable, that fome plants of the coniferous 
tribe, fuch as the fpruce fir, and others poffeff- 
ed of a diuretic power, may likewife be of 
fome ufe. 



MDCCCVI. 



It is fufficiently probable, that milk of every 
kind, and particularly its productions whey 
and butter milk, ma^flrove a cure of this 
difeafe. 



MDCCCVIL 

It has been common in this difeafe to em- 
ploy the foflil acids ; but there is reafon to 
doubt if they be of any fervice, and it is cer- 
tain they are not effedual remedies. They 
can hardly be thrown in in fuch quantity as 
tD be ufeful antifeptics ; and as they do not 
feem to enter into the compofition of the an- 
imal fluids, and probably pafs off unchanged 
by the excretions, fo they cart do little in 
changing the Hate of the fluids* 

MDCCCVIII, 



37* 



PRACTICE 



MDCCCVIII. 



The great debility which conftantly attends 
fcurvy, has naturally led phyficians to employ 
tonic and ftrengthening medicines, particular- 
ly the Peruvian bark ; but the efficacy of it 
feems to me very doubtful. It is furprifing 
how loon the ufe of a vegetable diet reftores 
the ftrength of fcorbutic perfons ; which 
feems to mow that the preceding debility had 
depended upon the ftate of the fluids ; and 
confequently, till the found ftate of thefe can 
be reflored, no tonic remedy can have much 
cffeft : But as the Peruvian bark has little 
power in changing the ftate of the fluids, fo 
it can have little effect in fcurvy. 

MDCCCIX. 

I fhall conclude my obfervations upon the 
medicines employed in fcurvy, with remark- 
ing, that the ufe of mercury is always mani- 
feftly hurtful. 

MDCCCX. 

After having obferved that both the pre- 
vention and cure of this difeafe are now very 
well known, it may feem unneceffary to enter 
into much difcuflion concerning its proximate 
caufe : But as fuch difcuflions can hardly be 
avoided, and as falfe opinions may in fome 

meafure 



OF PHYSIC. 

meafure corrupt the practice, I fhall venture 
to fugged here what appears to me moft prob- 
able upon the fubject. 

MDCCCXI. 

Notwithstanding what has been afferted by 
fome eminent perfons, I truft to the concur- 
ring teflimony of the molt part of the authors 
upon the fubjecl:, that in fcurvy the fluids 
fuffer a considerable change. 

From thefe authors we learn, that in the 
blood drawn from the veins of perfons la- 
bouring under the fcurvy, the cralTamentum 
is different both in colour and confidence 
from what it is in healthy perfons ; and that 
at the fame time the ferum is commonly 
changed both in colour and tafte. The ex* 
cretions alfo, in fcorbutic perfons, fhow a 
change in the ftate of the fluids. The breath 
is fetid ; the urine is always high coloured, 
and more acrid than ufual ; and if that acrid 
exfudation from the feet, which Dr. Hulme 
takes notice of, happens efpecially in fcorbutic 
perfons, it will be a remarkable proof to the 
fame purpofe. But however this may .be, 
there is evidence enough that in fcurvy the 
natural ftate of the fluids is considerably 
changed. Further, I apprehend it may be 
confidently prefumed from this, that the dif- 
eafe is brought on by a particular nouriftiment 
introduced into the body, and is as certainly 
cured by the taking in of a different diet. In 

Vol.' III. R the 



374 PRACTICE 

the latter cafe, the diet ufed has no other evi- 
dent operation, than that of giving a particu- 
lar ftate and condition to the fluids. 



MDCCCXII. 

Prefuming, therefore, that the difeafe de- 
pends upon a particular condition of the 
fluids of the body, the next fubject of inquiry 
is, What that condition may be ? 

With this view, I muft obferve, that the an- 
imal economy has a lingular power of chang- 
ing acefcent aliments, in fuch a manner, as to 
render them much more difpofed to putre- 
faction ; and although, in a living ftate, they 
hardly ever proceed to an actually putrid 
ftate ; yet in man, whofe aliment is of a mixed 
kind, it is pretty certain, that if he were to 
live entirely upon animal food, without a fre- 
quent fupply of vegetable aliment, his fluids 
would advance further towards putrefaction 
than is confident with health. This advance 
towards putrefaction feems to confift in the 
production and evolution of a faline matter 
which did not appear in the vegetable ali- 
ment, and could not be produced or evolved 
in it, but by carrying on its fermentation to a 
putrefactive ftate. That this faline ftate is 
conftantly in fome meafure produced and 
evolved by the animal procefs, appears from 
this, that certain excretions of faline matter 
are conftantly made from the human body, 

and 



OF PHYSIC. 

and are therefore prefumed neceflary to its 
health. * 

From all this, it may be readily underftood, 
how the continual ufe of animal food, efpec- 
ially when already in a putrescent (late, with- 
out a mixture of vegetable, may have the ef- 
fect of carrying the animal procefs too far, 
and particularly of producing and evolving a 
larger proportion of faline matter. That fuch 
a preternatural quantity of faline matter does 
exift in the blood of fcorbutic perfons, appears 
from the ftate of the fluids above mentioned. 
It will be a confirmation of all this to obferve, 
that every interruption of per fpi ration, that 
is, the retention of faline matter, contributes 
to the production of fcurvy ; and this inter- 
ruption is efpecially owing to the application 
of cold, or to whatever elfe weakens the force 
of the circulation, fuch as the neglect or want 
of exercife, fatigue, and defpondency of the 
mind. It deferves indeed to be remarked 
here, that one of the firft effects of the fcurvy 
once induced, is very loon to occafion a great 
debility of the fyftem, which occafions of 
courfe a more rapid progrefs of the difeafe. 
How the ftate of the fluids may induce fuch a 
debility is not well underflood ; but that it 
does depend upon fuch a ftate of the fluids, 
is rendered furficiently pre fum able from what 
has been fa id above with regard to both the 
caufes and the cure of fcur 

R 2 MDCCCXIII. 



376 PRACTICE 



MDCCCXIII. 

It is poflible, that this debility may have a 
great {hare in producing feveral of the phe- 
nomena of fcurvy ; but a preternaturally fai 
line,' and confequently diffolved ftate of the 
blood, will account for them with more prob- 
ability ; and I do not think it neceffary to 
perfons who are at all accuflomed to reafort 
upon the animal economy, to explain this 
matter more fully. I have only to add, that 
if my opinion in fuppofing the proximate 
caufe of fcurvy to be a preternaturally faline 
ftate of the blood, be at all founded, it will be 
fufficiently Obvious, that the throwing into 
the body along with the aliment an unufual 
quantity of faltj may haye a great fhare in pro- 
ducing the difeafe. £ven fuppofing fuch fait 
to fuffer no change in the animal body, the 
effect of it may be confiderable ; and this will 
be rendered flill more probable, if it may be 
prefumed, that all neutral falts, confiding of a 
fixed alkali, are changed in the animal body 
into an ammoniacal fait ; which I apprehend 
to be that efpecially prevailing in fcurvy. If 
1 be at all right in concluding, that meats* 
from being lalted, contribute to the produc- 
tion of fcurvy, it will readily appear, how dan- 
gerous k may be to admit the conclufion 
from another theory, that they are perfectly 
innocent, 

MDCCCXIV. 



OF P H Y S I U 377 



MDCCCXIV. 

Having thus endeavoured to explain what 
relates to the cure of fcurvy in general, I 
judge it proper to leave to other authors, 
what relates to the management of thofe 
fymptoms which require a particular treat- 
ment. 



R 3 CHAR 



378 PRACTICE 

CHAP. IV. 
of JAUNDICE. 

MDCCCXV. 

I HAVE here pafled over fev- 
eral of the titles in my nofology, becaufe they 
are difeafes not of this Ifland. In thefe, 
therefore, I have no experience ; and with- 
out that, the compiling from other writers is 
always extremely fallacious. For thefe rea- 
ibns I omit them ; and fhall now only offer 
fome remarks upon the fubjecl: of jaundice, 
the laft in order that I can poffibly introduce 
in my courfe of Leftures. 

MDCCCXVI. 

The jaundice confifts in a yellow colour of 
the fkin over the whole body, and particular- 
ly of the adnata of the eyes. This yellow 
colour may occur from different caufes : But 
in the jaundice, hereafter to be more exaclly 
charadterifed, I judge it to depend upon a 
quantity of bile pre fen t in the mafs of blood ; 
and which, thrown out upon the furface, 
gives its own proper colour to the fkin and 
eyes. 

MDCCCXVII. 



OF PHYSIC. 379 

MDCCCXVII. 

That the difeafe depends upon this, we 
know particularly and certainly from the 
caufes by which it is produced. In order to 
explain thefe, I muft obferve, that bile does- 
not exift in its proper form in the mafs of 
blood, and cannot appear in this form till it 
has parTed the fecretory organ of the liver. 
The bile therefore cannot appear in the mafs 
of blood, or upon the furface of the body, 
that is, produce jaundice from any interrup- 
tion of its fecretion ; and accordingly, if jaun- 
dice does appear, it muft be in confequence 
of the bile, after it had been fecerned, being 
again taken into the bloodveffels. 

This may happen in two ways ; either by 
an interruption of its excretion, that is, of its 
pafTage into the duodenum, which by accu- 
mulating it in the biliary veffels, may give oc- 
cafion to its pafling again into the bloodvef- 
fels ; or it may pafs into thefe, by its being 
abforbed from the alimentary canal when it 
happens to be accumulated there in an un- 
ufual quantity. How far the latter caufe can 
take place, or in what circum fiances it does 
occur, I cannot clearly afcertain, and I ap- 
prehend that jaundice is feldom produced in 
that manner. 

MDCCCXVIII. 

The former caufe of flopped excretion 

may be underflood more clearly ; and we 

R 4 have 



380 PRACTICE 

have very certain proof of its being the ordi, 
nary, and indeed almofl the univerfal caufe 
of this difeafe. Upon this fubject it will be 
obvious, that the interrupted excretion of the 
bile mull depend upon an obftruction of the 
duHus communis choledochus ; the moft com- 
mon caufe of which is a biliary concretion 
formed in the gall bladder, and from thence 
fallen down into the ductus communis, it be- 
ing at the fame time of fuch a fize as not to 
pafs readily through that duct into the duo- 
denum. This duct may likewife be obftruct- 
ed by a fpafmodic conftriction affecting it : 
And fuch fpafm may happen, either in the 
duct itfelf, which we fuppofe to be contractile ; 
or in the duodenum preffing the fides of the 
duct clofe together ; or, laftly, the duct may 
be obflructed by a tumour comprefling it, and 
that arifing either in the coats of the duct it- 
felf, or in any of the neighbouring parts that 
are, or may come to be, contiguous to it. 

MDCCCXIX. 



When fuch obftruction happens, the fe- 
creted bile muft be accumulated in the biliary 
ducts ; and from thence it may either be ab- 
forbed and carried by the lymphatics into the 
bloodveffels, or it may regurgitate in the ducts 
themfelves, and pafs from them directly into 
the afcending cava. In either way, it comes 
to be diffufed in the mafs of blood ; and from 

thence 



OF PHYSIC. 381 

thence may pafs by every exhalant veffel, and 
produce the difeafe in queftion. 

MDCCCXX. 

I have thus fhortly explained the ordinary 
production of jaundice : But it rauft be ob- 
served further, that it is at all times accompa- 
nied with certain other fymptoms, fuch as a 
whitenefs of the faces alvina, which we read- 
ily account for from the abfence of bile in the 
inteftines ; and generally, alfo, with a certain 
confidence of the faeces, the caufe of which it 
is not fo eafy to explain. The difeafe is al- 
ways accompanied alfo with urine of a yellow 
colour, or at leaft with urine that tinges a 
linen cloth with a yt'Ilow colour. Thefe are 
conflantly attending fymptoms ; and though 
not always, yet there is commonly a pain felt 
in the epigaftrium, correfponding, as we fup- 
pofe, to the feat of the ductus communis.. 
This pain is often accompanied with vomit- 
ing ; and even when the pain is not confid- 
erable, a vomiting fometimes occurs. In 
fome cafes, when the pain is confiderable, the 
pulfe becomes frequent, full, and hard, and 
fome other fymptoms of pyrexia* appear. 

" MDCCCXXI. 

When the jaundice is occafioned by 'tu- 
mours of the neighbouring parts compreffing 
the biliary duc\ I believe the difeafe can very 
. Vol. 3. R 5 feldonx 



382 PRACTICE 

ieldom be cured. That fuch is the caufe of 
jaundice, may with fome probability be fup- 
pofed, when it has come on in confequence of 
other dileafes which had fubfifted long before, 
and more efpecially fuch as had been attend- 
ed with fymptoms of obftrucled vifcera. Even 
when the jaundice has fubfiited long without 
any intermifTion, and without any pain in the 
epigaftrium, an external compreflion is to be 
iutpe6ted. 

MDCCCXXII. 

In fuch circumftances, I confider the dif- 
eafe as incurable ; and it is almoft only when 
the dileafe isoccafioned by biliary concretions 
obftru&ing the biliary duel, that we may com- 
monly expect, relief, and that our art may 
contribute to the obtaining it. Such cafes 
may be generally known, by the dileafe fre- 
quently difappearing and returning again ; by 
our finding, after the former accident, biliary 
concretions amongft the fasces ; and by the 
difeafe being frequently accompanied with 
pain of the epigaftrium, and with vomitings 
arifmg from fuch pain. 

MDCCCXXIII. 

In thefe cafes, we know of no certain and 
immediate means of expediting the paffage of 
the biliary concretions. This is generally a 
work of time, depending upon the gradual 

dilatation 



O F P H Y S I C. 383 

dilatation of the biliary duct ; and it is fur- 
prifing to obferve, from the fize of the Hones 
which fometimes pafs through, what dilata- 
tion the duel: will admit of. It proceeds, 
however, falter or flower upon different occa- 
sions ; and therefore the jaundice, after a va- 
rious duration, often ceafes fuddenly and 
fpontaneoufly. It is this which has given rife 
to the belief, that the jaundice has been cured 
by fuch a number and fuch a variety of dif- 
ferent remedies. Many of thefe, however, are 
perfectly inert, and many others of them (uch 
as cannot be fuppole.d to have any effect in ex- 
peding the paffage of a biliary concretion. I 
fhall here, therefore, take no notice of the nu- 
merous remedies of jaundice mentioned by 
the writers on the Materia Medica, or even of 
thofe to be found in practical authors ; but 
fhall confine myfelf to the mention of thofe 
that may with probability be fuppofed to fa- 
vour the paffage of the concretion, or remove 
the obftacles to it which may occur. 

MDCCCXXIV. 

In the treatment of this difeafe, it is, in the 
firft place to be attended to, that as the dif- 
tention of the biliary duct, by a hard mafs 
that does not eafily pafs through it, may ex- 
cite inflammation there ; fo, in perfons of tol- 
erable vigour, bloodletting may be an ufeful 
precaution ; and when much pain, together 
•with any degree of pvrexia occurs, it becomes 
R6 an 



384 P JK. A <J T 1 U E 

an absolutely neceffary remedy. In Some in- 
ftances of jaundice accompanied with thefe 
Symptoms, I have found the blood drawn 
covered with an inflammatory cruft as thick 
as in cafes of pneumonia. 

MDCCCXXV. 

There is no means of pufhing forward a 
biliary concretion that is more probable than 
the action of vomiting ; which, by compref- 
fing the whole abdominal vifcera, and partic- 
ularly the full and diftended gall bladder and 
biliary veffels, may contribute, Sometimes 
gently enough, to the dilatation of the biliary 
duel:. Accordingly vomiting has often been 
found ufeful for this purpofe : But at the 
fame time it is poffible, that the force exerted 
in the acT: of vomiting may be too violent, 
and therefore gentle vomits ought only to be 
employed. And either when, by the long 
continuance of the jaundice, it may be fuf- 
pected that the fize of the concretion then 
pairing is large ; or more efpecially when pain 
attending the difeafe gives apprehenfion of 
inflammation, it may be prudent to avoid 
vomiting altogether. 

MDCCCXXVI. 

It has been ufual in the jaundice to em- 
ploy purgatives ; and it is poffible that the 
aclion of the inteflines may excite the aclion 

of 



OF PHYSIC. 385 

of the biliary duels, and thus favour the ex- 
pulfion of the biliary concretion : But this, 
I think, cannot be of much effect, and the at- 
tempting it by the frequent ufe of purgatives, 
may otherwife hurt the patient. For this 
realon I apprehend, that purgatives can never 
be proper, excepting when there is a flow 
and bound belly. 

MDCCCXXVII. 

As the relaxation of the fkin contributes to 
relax the whole fyftem, and particularly to 
relieve the conftriftion of lubjacent parts ; 
fo, when the jaundice is attended with pain, 
fomentations of the epigaflrium may be of 
fervice. 

MDCCCXXVIII. 

As the folids of the living body are very 
flexible and yielding ; fo it is probable, that 
biliary concretions would in many cafes find 
the biliary duel; readily admit of fuch dilata- 
tion as to render their paflage through it eafy, 
were it not that the diftention occafions a 
preternatural fpafroodic contraction of the 
parts below. Upon this account, opium is 
often of great benefit in jaundice ; and the 
benefit resulting from its ufe, proves fufficient- 
ly the truth of the theory upon which the 
ufing of it has been founded. 

MDCCCXXIX. 



386 P R A C T I C E, &c. 

MDCCCXXIX. 

It were much to be wifhed, that a folvent 
of biliary concretions, which might be ap- 
plied to them in the gall bladder or biliary 
du£h, was difcovered : But none fuch, fo far 
as I know, has yet been found ; and the em- 
ployment offoap in this difeafe, I confider as 
a frivolous attempt. Dr. White of York has 
found a folvent of biliary concretions when 
thefe are out of the body ; but there is not 
the lead probability that it could reach them 
while lodged within. 



INDEX 




&i£%L 



f^> 



N 



D 



E 



X 



TO THE 



THREE VOLUMES. 

N. B. The Ciphers refer to the number of the Paragraphs. 



A, 



"-BSCESS, 2 co 

Abscesses and ulcers, the caufcs of their different 

flates, 254 

Acids employed in fever, i 34 

refrigerant in fever, 134 

Action or the heart and arteries, how increafed for 
preventing the recurrence of the paioxyfms of inter- 



mitting fever, 
Adynamic, 
Amenorrhoea, 



Amentia, 
Anasarca, 



from retention, 

when occurring, 
fymptoms of, 
caufes of, 
cure of, 
from fuppreflion, 

when occurring, 
fyni proms of, 
caufes of, 
cm e of 



the character of, 

phenomena of, 

cure of, 

diltinguifhcd from Leucophlegmatia, 



230 
1171 

995 
996 
998 

999 
1000 - 2 
1002- 6 
996 
1008 
1010 
1008 - 9 
1011— 13 
1598 
1668 
1668 
1668 73 
1674 96 
1669 
St. 



3 83 INDEX. 

St. Anthony's Fire. See Erythema. 
Antimonial emetics, employed in fevers, 181 

their different kinds, 181 

the adminiftration of 

them in fevers, 183—186 

Antiphlogistic Regimen, 129 

how condu6ted, 130 

when employed in inter- 
mittent fever, 234 
Antispasmodics, employed in fevers, 152—187 
Aphtha, 733 
Apoplexy, 1094. 
diftinguifhed from palfy, 1094 
diftingwifhed from fyncope, 1094 
predifponent caufes of, 1095 
exciting caufes of, 1098— 1115— 16 
proximate caufe of, uoo— 21 
serosa, proximate caufe of, 1114 
prognoftic, 1122—23 
frequently ending in hemi- 
plegia, 1122 
prevention of, 1124 
whether fanguine or ferous, flimulants 

hurtful in it, 1136 — 37 

from powers that deftroy the mobility of 

the nervous power, 1138 

cure of, 1131—39 

Apyrexia, 24 

Ascites, 1709 

charadter of, 1709 

its various feat, 1710— 11 

the phenomena of, 1712—13 

its particular ieat difficultly afcertained, 1714 

the cure of, I 7 I 5 — 17 

Asthma, 1373 

phenomena of, 1375 

exciting caufes of, 1381 

proximate caufe of, 1384 

diflinguifhed from other kinds of dyfpnoea, 1385 
fometimes occafions phthifis pulmonalis, 1386 

frequently ends in hydrothorax, 1386 

feldom entirely cured, 1387 

Astringents employed in intermittent fevers, 231 

joined with aromatics, employed in in- 
termittent fevers, 231 
joined with bitters, employed in inter- 
mittent fevers, 231 
Atrabilis, 1029 
Atrophia ab alvi fluxii, 1607 
debilium, 1606 
inanitoruai, 1607 

Atrophia, 



I N D 

Atrophia, infantilis, 
lactsmtium, 
lateralis, 
a leucorrhoea, 
nervofa, 
nutricum, 
* ptyalilnia, 
rachitica, 
fenilis, 

Aura Epileptica, 



B. 



X. 



389 

1605 
1605 

1606— 11 
1607 
1606 
1607 
1607 
1605 

i6c6— n 
1306 



Bitters employed in intermittent fevers, 231 

joined wth aftringents, employed in inter- 
mittent?, 3 j r 
Blistering, its effects, 189—197 
its mode of operation in the cure ©f 

fevers, 190—194 

when to be employed in fevers, 195 

where to be applied in fevers, 196 

Bloodletting, the employment of it in 

fevers, 138-143 

the circum fiances directing its uJe 

in fevers, 142 

the administration of it in fevers, 143 
when employed in intermittent 
fevers, 234 



Cachexies, character of the clafs, 
Cachexy, the tetni, how applied by authors, 
Calculus renalis, 

Calx nitrata antimonii, its ufe in fsvers, 
Canine madness, 

the cure of, 
Cardialgia, 
Carditis, 

of the chronic kind 
Carus, 
Cataphora, 
Catarrh, 

predifpofition to, 

fymptoms of, 

remote caufes of, 

proximate caufe of, 

cure of, 

produces phthifis, 

paffes into pneumonia, 

produces a peripneumonia notha, 



r 599 

1600 

429 

183-185 

1 S 2 S 

1427 
383 
383 
1094 
1094 
1046 
1047 
1048 
1047 
»°57 

IO J5 

i°54 

1056 

Catarrh, 



390 INDEX. 

Catarrh, contagious, 106a 

Catarrhus suffocativus, 376 

Chancre, method of treating, 17U1 

Chicken Pox, 631 

how diftinguifhed from {mall pox, 632 

Chincough, 1402 

contagious, 1402 

frequently accompanied with fever, 1410 

phenomena, 1404 

prognoftic in, 1413 

cure of, 1414 

Chlorosis, 998 

Cholera, 1453 

fymptoms of, 1453—56 

remote caufes of, 1458—60 

prox mate caufe of, 1454 

cure of, 1462-64 

Chorea, 1347 

phenomena, 1347 — 53 

cure of, 1354 

Chronic weaknefs, 1191 

Coeliaca, 1493 

Cold, its operations, 88 

abfolute, 88 

relative, 89 

its general effects on the human body, 90—91 

its morbid effects, 92 

moderates the violence of reaction in fever, 133 

its tonic power, how to be employed in fevers, 205 

Cold drink, an ufeful tonic in fevers, 206 

the limitation of its ule in fevers, 207 

air applied in fevers, 20» 

water applied to the furface of the body in 

fevers, 205—209 

Colic, 1435 

fymptoms of, 1435—3* 



proximate caufe of, 


1439 


cure of, 


444 1 


Devonlhire. See Colic of Poitou. 




of Poitou, 


145* 


cure of, 


1452 


Coma, 


1094 


Comata, 


1093 


Contagions, 


78 


their fuppofed variety, 


79 


Convulsions, 


"53 


Corpulency, 


1621 


Ctnanche, 


300 


MALIGNA, 


3'i 


PAROTIDEA, 


33* 


THARYNGEAj 


331 




Cynanche, 



INDEX. 391 

Cynanche, tonsillaris, 3or 

TRACHEAL1S, 31S 

as afFecYmg infants, 322—329 

the cure of it, 330 

Cystitis, 43I 

D. 

Days, critical, in fevers, 107 — 124 

noncritical, 113 

Death, the caufes of, in general, 100 

the direct caufes of, 100 

the indirect caufes of, 100 

the caufes of in fever, 101 

Debility in fevers, the fymptoms of, 104 

how obviated, 203 

Delirium in general, explained, 1529—50 

in fever of two kinds, . 45 

or insanity without fever, 1550— 57 

Diabetes, 1504 

Jymptoms of, 1504—9 

remote caufes of, 1508 

proximate caufe of, 1510 — 12 

cure of, 151 3 

DijETa Aquea, 157 

Diarrhoea, 1465 

diftinguifhed from dyfentery, 1466 

diftinguiflied from cholera, 1467 

proximate canfe of, 1468 

remote caufes of, 1471—93 

cure of, 1494—7503 

biliosa, 1480 

colliquative, 150c 

MUCOSA, 1488 

Diathesis phlogistica, 62—247 

how removed, 266 

Diluents, their ufe in fevers, I J4— 158 

Diseases, the diftinguifhing of them, how attained, 2 

the prevention of them, on what founded, 3 

the cure of them, on what founded, 4 

Dropsies, 1645 

in general, the caufe of them, 1646 

of the breafr. See Hydrothorax. 

of the lower belly. See Afcites. 

Dysentery, joSj 

contagious, 1075 

remote caufes of, 1072 

proximate caufe of, 1077 

cure of, 1080 

ufe of mild cathartics to be frequently 

repeated in it, 1080 

Dysentery, 



392 INDEX. 

Dysentery, rhubarb improper in it, 1080 

Dysenteria alba, 1070 

Dysmenorrhoea, 1014 

Dyspepsia, 1190 

remote caufes of, 1 198 

proximate caufe of, 1193 

cure of, 1 soi 

flatulence in it, cure of, 1221 

heartburn in it, cure of, 1221 

pains of ftomach in it, cure of, 1221 

vomiting in it, cure of, 1221 

Dyspnoea, 1365 

E. 

EFFLUviA/human, 85 

from marfhes, 85 

Emaciations, 1600 

caufes of, 1602—18 

cure of, 1619 

Emansio mensium, 998 

Emetics, fuited to the cure of fevers, 174 

their effects, 176—180 

a mean of removing fpafm, 170 

the adminiftration of in fevers, 175 

their ufe in intermittent fevers, 230—233 

Emprosthotonos, 1267 

Enteritis, 404 

phlegmonic or erythematic, 404 

caufes of, 407 

cure of, 409 

Epilepsy, 1282 

phenomena of, 1283 

proximate caufe of, 1284 

remote caufes of, 1285 

predifponent caufes of, nio 

iympathic, J3>6 

cure of, 1 3 17 

idiopathic, 13 16 

cure of, i3 J 9 

Epistaxis, »o6 

the caufes of it, 808 

the various circumftances of, 807 — 818 

the management and cure of, 819 — 829 

Erysipelas, *74 

of the face, 708 

fymptoms of, 705 — 708 

prognofis of, 706 

proximate caufe of, 697 

cure of, 7°S — 7'* 

phlegmonodes in different parts of the body, 712 

Erysipelas, 



INDEX. 393 

Erysipelas, attending putrid fever, 7>3 

Erythema, »7+ 

Exanthemata, 585 

Exercise, ufet'ul in intermittent fevers> &3 1 

( F. 

Fainting. See Syncope. 1171 

Fatuity, 1529 

Fear, a remote caufe of fever, 97 

Fever, 8 

ftrictly fo called, the character of, 8—32 

phenomena of, 8 

remote caufes of, are of a fedative nature, 36 

proximate caufe of, 33 

atony of the extreme veflels, a principal cir* 

cumftance in the proximate caufe of it, 43 — 44 

f pafm, a principal part in the proximate caufe 

of it, 4° 

general doctrine of, 46 

the caufes of death in it, joi 

the prognofis of, 99 

indications of cure in, 116 

differences of, 53 

continent, a$ 

continued, *7 

inflammatory, *7 
miliary. See Miliary Fever. 

nervous, 67 

bilious, 71 
fear let. See Scarlet Fever. 

putrid, 72 

named fynocha, 67 

fynochus, 69 

typhus, 67 

hectic, 74 

intermittent, the paroxyfms of, defcribed, 10 

the cold ftage of, 11 

the hot (iage of, 11 

the fweating ftage of, it 

of a tertian period, 25 

of a quartan period, 25 

of a quotidian period, 25 

cauied by maifh effluvia^ 84 

bile not the caufe of it, 51 

cure of, 228 

its paroxyfms, how prevented, 229 

attended with phlogiltic diethefis, 234 

attended with congeftton in the 

abdominal Tiiceia, 234 

remittent, 26 

Fluxes, 






394 INDEX* 

Fluxes, without fterer. See Proflwuia. 
Fluor albus. See Lettcorrhcea. 
Fomentation of the lower extremities, its ufe in 

fevers, 199 

Fomites of contagion, , 82 

Functions intellectual, diforders of, 1528—29 

G. 

Gangrene of inflamed parts, the catife of, 255—256 

marks of the tendency to, 257 

I marks of its having come on, 257 

Gastritis, 384 

phlegmonic or erythematic, 385 

phlegmonic, the feat of, 385 

the fymptoms of, 386 

the caufcs of, 387 

the cure of, 393—397 

erythematic, how difcovered, 4.00 

the feat of, 385 

the cure of, 401 

Gastrodynia, 1427 

Gleet, 1769 

Gonorrhoea, 1765 

phenomena of, 1767 — 69 

cure of, 1770—78 

Gout, the character of, 492 

a hereditary difeafe, 500 

diftinguifhed from rhevimatifm, 526 

predifponent cau/es of, 493 — 500 

occafional caufes of, 502 — 505 

proximate caufe of, 527 — 533 

, not a morbific matter, 529 

Regular, defcriued, 506—518 

pathology of, 533 

cure of, 537—573 

no effectual or fafe remedy yet found 

for the cure of it, 539 

medicines employed for it, 556 

whether it can be radically cured, 540 
treatment in the intervals of p irox- 

yfms, 542 
treatment in the time of paroxyfms, 560 

regimen during the paroxyfms, 561 
external applications, how far 

fafe, 568—5(19 
bloodletting in the intervals of 

paroxyln.s, 553 

in the time of parox- 

vims, 563 

co(hve»nef5 hurtful, 559 

Gouf, 



1 N D E X. 395 

Govt, Regular, laxatives to be employed, 559 

effects of alkalines, rcg 

effects of Portland powder, rr 7 

Irregular, " s 

pathology of, 534 

cure of, 5 3o- 5 ?z 

RetroceJent, r 2it 

pathology of, 535 

M,fplaced, > 

pathology of, 53 6 

cure of, 583—584 

Tranjlated, two particular cafes of, 525 

H. 

•Hjematemesis, IO17 

arterial and venous, 1027 

from obllrucled nienftruation, 1020 
from fuppreflion of the hemorrhoidal 

flux, , 02S 
iromcompreflion of the vafa brevia, 

by ihe fpleen, 1017 

from obstruction of the liver, 1028 

Hematuria, 7033 

idiopathic, improbable, 1033 — 34 

calculofa, 1037 

cure of, 10-38 

violenta, 1039 

from fuppreflion of accuftomed dif- 

charges, I04 i 

putrida, 10^1 

fpuria et lateritia, 1044 

HiEMlFLEClA, , , II4 o 

caufes of, 1 , 4I 

frequently occafioned by apoplexy, 114a 

frequently alternates with apoplexy, 1 144 

cure of, ,, 52 

flimulants, of ambitious ufe in, 1160 

ftimuiants, external, in, u6i 
HEMOPTYSIS, 

the fymptoms of, 838—240 

thecaulesof, 760—63—830—836 

how diftinguifhed from other fpittings 

of blood, 84r~45 

Mire of, 846-52 

Hemorrhagia uteri, 566 

Hemorrhag V, 

active or paflive, 735 

character of, 736 

Hemorrhagy, 



396 INDEX. 

Hemorrhagy, arterial, 744, 

venous, 768 

the caufes of the different fpecies 

appearing at different periods 

of life, 750— 773 

the general phenomena of, 738—743 

the remote caufes of, 774. 

' cure of, 776 

1 whether to be attempted 

by art, 776-81 
prevention of the firft attacks, or 

of the recurrence of, 781—789 

treatment of when prefent, 789—805 

fymptomatic, 1015 

ji^emorrhoides vesicae, 104a 

Hje.morrhois, 

external and internal, 925 

phenomena of, 9 a 5—- 931 

nature of the tumours, 931 

caufes of, 933 — 943 
acquire a connexion with the fyf- 

tem, ' 943—944 

particularly with the flomach, 946 

cure of, 947—065 

HePATIRRHOEA, 1481 

Hepatitis, 4" 
acute and chronic, 412 
acute, the fymptoms of, 413—415 
combined with pneumonic inflam- 
mation, 416 
remote caufes of it, 416 
feat of, 4 l8 
various exit of pus produced in, 411 
cure of, 4 a * 
chronic, the feat of, 418 
how difcovered, 423 
HOOPIN'GCOUCH. See Chlncough. 140a 
Horror, imprelh'on of, employed in intermittent 

fevers, a 3' 

Human effluvia, the caufe of fever, 81 

body, its temperature, 88 

body has a power of generating heat, 83 

Hydrophobia, . 1525 

iivdrothorax, 1697 

where feated, 1693 

fymptoms of, 1701—013 

often combined with univerfal 

dropfy, 1704 

proximate caufe of, 1706 

cure of, 1707—08 

paracentefis in it, when proper, 1708 

HYFERCATKARblS, 



N 



n 



x. 



Hypercatharsis, 
Hypochondriasis, 

phenomena of, 
diflinguifhed from dyfpepfia, 
proximate caufe of, 
cure of, 

treatment of the mind in, 
Hysteria, 

lymptoms of, 

paroxyfm or fit defcribed, 

rarely appears in males, 

how diftinguifhed from hypochondri- 

afis, 
proximate caufe of, 
analogy between and epilepiy, 
cure of, 
libidinofa, 
•Hysteric difeafe. See Hyfieria. 



397 

H77 
1222 
1222 
1226 
1230 
1232 
1244 
i5 r 4 
1515-1* 

'5i7 

1518—19 
152Z 

*sn 

»524 
*5'7 



I. 



James's powder, its ufe in fever, 
Jaundice, 

caufe s of, 
cure of, 
Icterus. See Jaundice. 
.Iliac pafiion. See Ileus. 
Ileus, 
Impetiginis, 

character of the order, 
Indigestion. See Dyffepfta. 
Inflammation, the phenomena of, 

internal, the mirks of, 
the ftate of the blood in, 
the proximate cauie of, 
not depending upon a lentor 

of the blood, 
Ipalm the proximate caufe 

of, 
terminated by refolution, 
by fuppuration, 
by gangrene, 
by Fcirrhus, 
by effufion, 
by bliders, 
by exludation, 
the remote caufes of, 
the cure of in general, 

by refolution, 



1815-16 
1816 — 2r 
1823—29 



1437 
i/37 
*737 

235 
236 

237 
239 

24 r 

243—248 
249 
350 
2 S5 

'I 9 
260 

z6z 

262 

264 

264 



Vol. III. 



Inflammation, 



398 INDEX. 

Inflammation, the cure of, when tending to Sup- 
puration, 268—70 
when tending to gan- 

its general divifions, 27 j 

more ftrictly cutaneous, 374 

of the bladder. See Cyflitis. 

of the brain. See Pbrenitis. 

of the heart. See Carditis. 

of the inteftines. See Enteritis. 

of the kidneys. See Nephritis. 

of the liver. See Hepatitis. 

of the lungs. See Pneumonia. 

of the pericardium. See Pericarditis. 

of the peritonaeum. See Peritonitis. 

of the fpleen. See Splenitis. 

of the ftomach. See Caftritis. 

of the uterus, 432 

INSANITY, 1535 

caufes of, *5JO- 57 

of different fpecies, 1557 

partial and general, difference of, 1575 
Intemperance in drinking, a remote caufe of 

fever, 97 

Intermission of fever, 24 

Interval of fever, 24 

IntumescentijE, 1620 

character of the order, 1620 

K. 

King's evil. See Scropbula, 

L. 

Leucophlegmatia, , 1669 

Leucorrhoea, * 9 8 | 

character of, 9™ 

appearance of the matter difcharg- 

ed in, 987—99 

the caufes of, 988 

the effects of, 990 

the cure of, 993 

IS 



Lethargus, 

LlENTERV, 



Looseness. See Diarrhaa. 
M. 

Madness. See Mania . 

canine. See Canint. 

Mania, 



I N D ii a. , 399 

Mania, I55 g 

the fymptoms of, 1558 

the remote caufes of, 1559-61 

the treatmt nt of, 1562 -74 

occurring in ianguine temperaments, 1576 

in fanguine temperaments, cure of, 1 07 

Marc ores, ,6 00 

Marsh effluvia, a can fe of fever, 84 

Measles, 633 

the fymptoms of, 637—643 

the nature of, 644 

the cure of, 645 — 650 

of a putrid kind, 643 

Medicine, the institutions of, 4 

Mel*na, 1017 

Melancholia, 1575 

how diftinguifhed from hypochon- 

driafis, 1587—88 

the chat-after of, 1582—89 

the proximate caufe of, 1590 

the treatment of, 1592—97 

Melancholic temperament, 1230 

Melancholy. See Melancholia . 

Menorrhagia, 966 

active or paffive, 966 

when a dileafe, 968—75 

effects of, 972 

proximate caufe of, 977 

remote caufes of, 978 

cure of, 980 

Menses, immoderate flow of them. See Menorrhagia. 
Metallic tonics, employed in intermittent 

fevers, 231 

salts, refrigerant, 136 

Meteorismus, 1633 

Miasmata, 78 
Miliary fever, 

the general hiftory of, 714—715 

of two kinds, red and white, 716 

white, the fymptoms of, 717 — 7*9 

the cure of, 720 

Morbus coeliacus, 1493 

mucosus, 1070 

NIGER, IO29 

N. 

Nephritis, 4 j6 

the fymptoms of, 426 

the remote caufes of, 427 

the ctsre of, 43° 

«, Nervous 



400 INDEX. 

Nervous Diseases. See Neurofes.. 

Neuroses, ioj« 

Neutral Salts, diaphoretic in fevers, 159 — 161 

refrigerant in fevers, 135 

Nosology, Methodical, a 

O. 

Obesity, when a difeafe, 1621 
Oneirodynia, 1598 
Ophthalmia, 278 
membranarum, 278 
its different de- 
grees, 279—280 
its remote caufes, 280 
the cure of, 288—290 
tarn*, 278 
the cure of, 288—290 
OriATES, employed in the hot ftage of intermittent 
fevers, 233 
in the interval of intermittent fevers, 231 
Opisthotonos. See Tetanus. 

P. 

Palpitatisn of the heart, 1355 

the phenomena of, 1355 

the caufes of, 1356 

the cure of, 1363 

Palsy, U40 

diflinguifhed from apoplexy, 1094 

caufes of, 1141 

Paracentesis in afcites, when to be attempted, 1717 

in hydrothorax, when proper, 1708 

PARAPHSENITIS, 343 

Paroxysm of intermittent fevers, the recurrence, 

how to be prevented, 229 

Pemphigus, 732 

Pericarditis, 383 

Peripneumonia notha, 376 

* fymptoms of, 379 

pathology of, 380 

the cure of, 381—382 

fome of the fymptoms ex- 

v plained, 350 

Peripneumony, 342 

Peritonitis, 384 

Peruvian Bark, not a fpecific, 213 

its tonic power, 214 

when proper in fever, 215 

how nioft effectually employed, 216 

Peruvian 



INDEX. 401 

Peruvian Bark, the adminiftration of, in inter- 
mittent fevers, 232 
the tonic chiefly employed in inter- 
mittent fevers, 232 
Petechia, 734 
Phlegmasia, 235 
Phlegmon, 274 
Phrenitis, 291 
the character of, 293 
the remote cauies of, 294 
the cure of, 2 95~" 2 99 
PHREN'SY. See Phrenitis. 

Physic, the practice of, how taught, r 

the theory of, how to be employed, 4 

Physconia, i7 lS 

Phthisis pulmonalis, the general character of, 853 

always witli an ulceration of 

the lungs, - 855 

the pus coughed up in, how 

diltmguifhed from mucus, 856 
accompanied with hectic 

fever, 857 

the various caufes of it, 863 

from haemoptyfis, 864—865 

from pneumonia, 866 — 869 

from catarrh, 870—873 

from afthma, 875 

from tubercles, 876— 88z 

from calcareous matter in 

the lungs, 884 

if contagious, 886 

from tubercles, fymptoms 

of, 889 

its different duration, 896 

the prognofis in, 897 

the cure of, 899—924 

the treatment of when 
arifing from tuber- 
cles, 906—921 
the palliation of fymp- 
toms, 922—924 

Plague, , , .. 

trie general character of, 665 

phenomena .of, 665 

principal fymptoms of, 667 

proximate caufe of, 668 

prevention of, 670—685 

cure of, 686-695 

Pleurisy, 34* 

Pleurosthotonos. See Tetanus. 



Pneumonia, 



Vol. 3. 



402 



N 



D 



X. 



PNEUMONIA, or PNEUMONIC INFLAMMATION, 334 

general fymptoms of, 335— 339 

feat of, 34°~344 

prognosis of, 352-363 

cure of, T,(>i 

the management of bloodletting in 

the cure of, 362—367 

the ufe of purgatives in, 370 

the ui'e of emcics in, 
the ule of bliliers in, 
the means of promoting expectoration 

in, 
the ufe of fweating in, 
the ufe of opiates u, 
Polysarcia, when a dilcale, 

cure of, 1623 

Profluvia, 

character of the clafs, 
Puls.e, the (late oi the, during the paroxyfm of an 

intermittent fever, 
Purging, its ufe in continued fevers, 

intermittent fevers, 
Pus, how produced, 

Putrescency of the fluids in fever, the fymp- 
toms of, 

the tendency to in fever, how to be 



37i 
372 

373 

374 

375 

1621 

25 
'045 
I0 45 

12 

144 

234 
250 

"5 



corrected, 

Pylorus, scirrhous. See Djfpepjia. 
Pyrexiae, 

character of the clafs, 
orders oi the clafs, 
Pyrosis, 

fymptoms of, 
proximate cattle of, 
remote caules of, 
cure of, 
Suecica of Sauvages, 



222—226 

6 
6 

7 
J427 

1431 
M33 
H32 
1434 
1428 



Quinsy. See Cynancbe. 



CL. 



R. 



Rachitis, 



its origin, 
remute caufes of, 
phenomena of, 
proximate caufe of, 
cure of, 



1719 

1720 

1721 23 

1724 

1725 -28 

1729-36 

Reaction 



INDEX. 403 

Reaction of the iyflem, 59 

violent in fever, fymptoms of, 103 

violence of, how moderated, 127 

Refrigerants, the ufe of them in fever, 134 

Remedies, table of thole employed in continued 

fevers, 22 - 

Remission of fever, 26 

Resolution of inflammation, how produced, 249 
Respiration, the changes of, during the paroxyfm 

of an intermittent, 13 

Revolution, diurnal, in the human body, 55 

Rheumatism, acute or chronic, 433 

Acute, the remote caufes of, 436' 

the proximate caufe of, 455—460 

the fymptoms of, 439—447 

cure of, 461 — 470 

Chronic, fymptoms of, 450 

how diftinguilhed from the 

acute, 451 

proximate caufe of, 472 

cure of, 473—476 
how diftinguifhed from gout, 526 
Rickets. See Rachitis, 
Rose. See Erythema. 
Rubefacients, the effects of them. 

S. 

Scarlet fever, 651 
the fymptoms of, 656 
different from cynanche ma- 
ligna, 651—655 
the cure of> 657—664 
Scrophula, 1738 
the phenomena of, 1738 -1749 
the proximate caufe of, 1750 
not contagious, 1751 
not arifing from the lues venerea, 1752 
the cure of, 1753 59 
Mefenterica, 1606 
Scurvy, 1789 
remote caufes of, 1792 — 1802 
cure of, 1804 09 
proximate caufe of, 1811--14 
Sinapisms, the effects of them, 197 
Skin, affeclions of. See lmpetiginis. 

Small Pox, general character of, 587 

lymptoms of the diftinct kind, 589 

of the confluent kind, 59^-593 

general differences between diftinft 

and confluent, 594 

Small 



4°4 



N D E X. 



Small Pox, caufes of thefe differences, 595—600 

prognofis in, 593 

cure of, 601—630 

inoculation of, 602 

the feveral practices of 

which it confifts, 603 

the importance of the 
feveral practices be- 
longing to, 604—615 
management of fmall pox received by 

infection, 616—630 

Soda, 1427 

Spasm, internal, means of removing in fevers, 152—187 
the proximate caufe of inflamma- 
tion, 243—248 
Spasmodic affections without fever, 1251 
of the animal fundtions, 1254 
of the vital functions, 1355 
of the natural functions, 1427 
Sphacelus, 255 
Splenitis, 425 
Stimulants, when to be employed in fevers, 217 
their ufe in intermittent fevers, 230 
Stomach, its confent with the veflels on the iurface 

of the body, 44 

Sudorifics, arguments for their rife in fevers, 163-167 

againft their ufe in fevers, 164 

Suppuration of inflamed parts, the caufes of, 251 

the marks of a tendency to, 251 

formed, the marks of, 25 r 

Surface of the body, its confent with the ftomach, 44 

Swellings, general. See Intumefcentia. 

adipofe, 1621 

flatulent, 1626 

watery. See Dropjies. 
Sweating, when hurtful in continued fevers, 165 

rules for the conduct of in continued 

fevers, 16S 

ufe of in intermittent fevers, 230 

Syncope, "7 1 

phenomena of, 1171 

remote caufes of, 1 174 — 117 8 

predifpofition to, 1184 

cure of, 1189 

diftinguifhed from apoplexy, 1094 

Synocha. See Fever. 

Synochus. See Fe<ver. 

Syphilis, 176° 

originally from America, ,1761 

how propagated, 1762 

•and gonorrhoea, howdiftiogtiiihed, 7764 

Syphilis, 



I N 
Syphilis, cure of, 



X. 



405 

1783—88 



Tabes a hydrope, 

a (anguifluxu, 
dorfalis, 
glandularis, 
melenterica, 
nutricum, 
rachialgia, 
fcrophulofa, 
Tartar emetic, its ufe in fevers, 
Tetanus, 

remote caufes of, 

cure of, 

piflileum Barbadenfe, or Barbadoes tar, 

LATERALIS, 

Tonic medicines employed in continued fevers, 

intermittent fevers 
Toothach, how far different from rheumatilm, 

fymptomsof, 

predifpofition to, 

remote caufes of, 

proximate caufe of, 

cure of, 
Trismus. See Tetanus. 

NASCENTIUM, 

Tussu. See Catarrh. 
Tympanites, the character of, 

the different fpecies of, 

inteftinalis, 

enterophyfodes, 

abdominalis, 

afciticus, 

phenomena of, 

proximate caufe of, 

cure of, 
Typhus. See Fever. 

the fpecies of, 

V. 

Vapours,, or low fpirits. See Hypochondriacs. 
Venereal disease. See Syphilis. 
Vknery, excels in, a remote caufe of fever, 
Vesani^e, 

in general, 
Vis medicatrix naturae, 
St. Vitus's dance. See Chorea, 



in 



1609 

1608 

1610 

1606 

1606 

j 608 

1606 

1606 

185 

1257 

1268 

1270 

1280 

1268 

an 

231 

477-480 

478 

481 

481—482 

483 

485—491 

1281 

1627 

1628—30 

1628 

1628 

1628 

1628 

1632 

1635 — 36 

1637-44 

70 



97 

1528 
38 



Vomiting 



406 



N 



D 



X. 






Vomiting of blood. See Heematemefis. 

eftedts ot in continued 
fevers, 
the ufe of in intermitting fevers, 
Urine, bloody. See Hatnaturia. 
Urticaria, the hiitory and treatment of, 

W. 

Water brash. See Pyrofis. 

Whites. See Leucorrhoea. 

Warm bathing, the effects of in fever, 

the adminiltration of in fevers, 
the marks of the good effects, 
Wine, the moft proper ftimulant in fevers, 
its convenient ufe in fevers, 
when hurtful or uleful in fevers, 



>7*. «73 
230—34 



730 



198 
199 
200 
218 
219 
220 



^e®.©^ 







w* 



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